Major haemorrhage in pubic rami fractures.
A 62-year-old man presented to the emergency department, having fallen 6 ft from a ladder, with pain over his left hip and shoulder. He was managed according to the Advanced Trauma Life Support (ATLS) protocol, and his primary survey showed no haemodynamic compromise. Initial radiographs showed a unilateral left superior and inferior pubic rami fracture, which was treated conservatively. Forty-eight hours post-admission, the patient became tachycardic and hypotensive and was found to have dropped his haemoglobin from 125 to 89 g/L. After resuscitation, a repeat contrast CT scan revealed an enlarging haematoma in his pelvis. This was treated with urgent angioembolisation and the patient was further stabilised in the intensive care unit. This report shows the need for a low threshold in suspecting intrapelvic bleeds in patients with pubic rami fractures, and the need for prompt treatment of such patients, either surgically or radiologically.
Department of Trauma and Orthopaedics, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, Nottinghamshire, UK.
Chun Hong
CH
Tang
Department of Trauma & Orthopaedics, Queen's Medical Centre, Nottingham, Nottinghamshire, UK.
Faiz
F
Shivji
Department of Trauma and Orthopaedics, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, Nottinghamshire, UK.
Daren
D
Forward
D000058:Accidental Falls; D004621:Embolization, Therapeutic; D050723:Fractures, Bone / Q000150:complications* / Q000000981:diagnostic imaging; D006406:Hematoma / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011630:Pubic Bone / Q000293:injuries*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome