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Journal of Bone and Joint Surgery - British Volume, Vol 84-B, Issue 2,
178-182.
doi: 10.1302/0301-620X.84B2.12324 Copyright © 2002 by British Editorial Society of Bone and Joint Surgery The role of angiography in the management of haemorrhage from major fractures of the pelvisR. E. Cook, FRCS Ed, Specialist Registrar; and J. F. Keating, MPhil, FRCS Ed, Consultant Orthopaedic SurgeonEdinburgh Orthopaedic Trauma Unit I. Gillespie, FRCR, Consultant Radiologist Department of Radiology, Royal Infirmary of Edinburgh, Lauriston Place, Edinburgh EH3 9YY, UK. Correspondence should be sent to Mr J. F. Keating. In a series of 150 consecutive patients with unstable fractures of the pelvis, angiography was performed in 23 (15%) who had uncontrolled hypotension. There were three anteroposterior compression (APC), eight lateral compression (LC) and 12 vertical shear (VS) injuries. Arterial sources of haemorrhage were identified in 18 (78%) patients and embolisation was performed. Angiography was required in 28% of VS injuries. The morphology of the fracture was not a reliable guide to the associated vascular injury. Ten (43%) patients died, of whom six had had angiography as the first therapeutic intervention. Five of these had a fracture which was associated with an increase in pelvic volume (APC or VS) which could have been stabilised by an external fixator. Based on our findings we recommend skeletal stabilisation and, if indicated, laparotomy to deal with sources of intraperitoneal blood loss before pelvic angiography. Embolisation of pelvic arterial bleeding is a worthwhile procedure in patients with hypotension which is unresponsive to these interventions. This article has been cited by other articles:
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