title: Multifocal arterial haemorrhage in a partially stable pelvic fracture after a crush injury: a case report.
abstract: BACKGROUND
  Most pelvic haemorrhages are thought to be caused by injury to small arteries or veins in the fractured cancellous pelvic bone or in the surrounding soft-tissues, and only 6-18% of patients with unstable pelvic fractures have haemorrhage from larger arteries. When arterial injuries are present, the majority involve branches of the internal iliac artery with only few published reports of injuries to the external iliac artery or its branches.
  
  
  METHODS
  We report of a patient who sustained a combined pelvic and acetabular fracture with multifocal bleeding involving branches of both the internal iliac as well as the external iliac arteries after a crush injury. The primary attention was focused on the most probable arterial injury, the internal iliac artery and only at repeat angiography was the injury to the internal epigastric artery, caused by degloving injury to the trunk, recognized.
  
  
  RESULTS
  Arterial control was achieved only following aggressive fluid resuscitation, pelvic packing, repeated embolization and ligation of the peripelvic inferior epigastric artery. After initial haemodynamic control was achieved, the patient sustained multiple complications, partly as a consequence of the injury, but also as a consequence of the life-saving treatments.
  
  
  CONCLUSIONS
  The case describes a rare combination of arterial injuries in a complex pelvic fracture constituting a partially stable pelvic fracture and a dislocated acetabular fracture in a patient with pelvic crush injury and a degloving injury to the trunk. The case also describes the complex nature of these injuries and rarely reported problems related to the treatment of them.
authors.affiliation: Orthopaedic Centre, Ullevål University Hospital, Kirkeveien 166, Oslo, Norway. anna.totterman@ioks.uio.no
authors.forename: Anna
authors.initials: A
authors.lastname: Tötterman
authors.forename: Jan Erik
authors.initials: JE
authors.lastname: Madsen
authors.forename: Olav
authors.initials: O
authors.lastname: Røise
mesh_terms: D000063:Accidents, Traffic; D000077:Acetabulum / Q000293:injuries; D000328:Adult; D000792:Angiography; D001803:Blood Transfusion / Q000379:methods; D003444:Crush Syndrome / Q000175:diagnosis / Q000628:therapy*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods; D050723:Fractures, Bone / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006470:Hemorrhage / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006488:Hemostasis, Surgical / Q000379:methods; D006801:Humans; D007083:Iliac Artery / Q000293:injuries*; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis / Q000601:surgery; D010384:Pelvic Bones / Q000293:injuries*; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D018570:Risk Assessment; D012771:Shock, Hemorrhagic / Q000175:diagnosis / Q000628:therapy*; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis / Q000628:therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome