Hemorrhage associated with major pelvic fracture: a multispecialty x

---

challenge. x Moreno C. Moore EE. Rosenberger A. Cleveland HC. x Journal of Trauma. [JC:kaf] 26(11):987-94, 1986 Nov. x Definitive treatment of life-threatening hemorrhage associated with blunt x pelvic fracture remains controversial. To elucidate this issue, we x reviewed 538 consecutive patients admitted with acute pelvic fracture x during a 5-year period. Injury mechanism was motor vehicular in 214 (40%), x falls in 152 (28%), auto-pedestrian in 92 (17%), motorcycle in 46 (9%), x crush in 26 (5%), and assault or skiing in eight (1%). Ninety-two (17%) of x these patients required greater than 6 units of blood transfusion during x the first postinjury day, and are the primary focus of this report. Twenty x -five patients (28%) had unilateral anterior (Group I, n = 20) or x posterior (Group II, n = 5) fractures. The remaining 67 patients (72%) had x anterior and posterior element involvement on the same side (Group II, n = x 38), bilaterally (Group IV, n = 14), or open perineal wounds (Group V, n = x 15). The PASG was applied in 47 patients (51%), and controlled hemorrhage x in 12 (71%) of the 17 in whom it was used alone to tamponade pelvic x bleeding. Peritoneal lavage was performed in 73 patients (79%). Initial x aspirate yielded gross blood in 32 patients; 27 (84%) of these required x urgent laparotomy. External skeletal fixation was applied in 19 patients; x bleeding was controlled in 18 (95%). Pelvic angiography identified active x hemorrhage in three patients and selective embolization was successful in x two. Sixty-eight (74%) of the high-risk patients survived. Thirteen (54%) x of the 24 deaths were attributable to the pelvic trauma, ten were due to x recalcitrant bleeding, and three to delayed sepsis.