Pelvic Fractures-Associated Blood Loss and Therapeutic Intervention

At the time of a traumatically induced pelvic fracture, some degree of hemorrhage is inevitable. The principal sites of bleeding are outlined. The anticipated sites of major hemorrhage correlate with the region of the pelvis fracture, the vector of the provocative blow, and the magnitude of pelvic displacement.

For example, a displaced fracture of the posterior ilium that exists through the roof of the greater sciatic notch is likely to be associated with an injury to the superior gluteal vessels.

The principal sites of hemorrhage after a pelvic fracture

Intraosseous vessels

Periosteal, capsular, and adjacent intramuscular vessels

Intrapelvic vessels

Glueal

Obturator

Pudental

Hypogastric

External and internal iliac

Common iliac and aorta

Intraabdominal bleeding

Visceral

Major intraabdominal

External bleeding through an open wound

For displaced fracture with marked external rotation pelvis, in which the ligaments of pelvic floor are disrupted, a large volume of blood may collect in the retroperitoneal space and extravasate into the scrotum, the lights, and superiorward.

With pelvic fracture, the volume of blood that may be extravasated around the pelvis is truly large may require is many times over the blood volume.

The outcomes of pelvic trauma can be minimized by

• Immediate immobilization of the pelvis
• Correction of major deformit
• Liagture of offending vessel
• General resuscitation of the patients.

In open pelvic fractures, packing is a critical measure to provide tamponade.

In addition there could be cutaneous effects of pelvic trauma

• Extensive ecchymosis and soft-tissue swelling (Grey Turner syndrome)
• Disruption of the subcutaneous fat along with ecchymotic skin and potentially the deep fascia (Morelle-Lavelle lesion)
• Open wounds around the pelvic
• Perineal laceration or puncture wound
• Presacral laceration
• Perineal or vaginal laceration

The skin disruptions as well as visceral injuries provide a source of contamination for the bone and can lead to an infection of the pelvis and hip joint.

Potential Source of Infection for the Injured Pelvis and Hip Joint

• Open fracture-dislocation with cutaneous penetration
• Pelvic fracture with an injury of the large or small bowel
• Communication of the pelvic fracture with the bladder or urethra
• Communication of the pelvic fracture with vagina

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