title: Massive haemorrhage following minimally displaced pubic ramus fractures.
abstract: BACKGROUND
  Fractures of the pubic rami are the most frequent osteoporotic pelvic fracture. Although generally innocuous, epidemiologic research demonstrated a decreased survival in patients with pubic rami fractures compared to healthy controls. Sporadic cases of potentially lethal bleedings have been reported. The aim of this study was to report a consecutive series and review of the literature of patients with severe bleeding following minimally displaced pubic ramus fractures.
  
  
  METHODS
  We report on four cases who presented at our emergency department in 2012 and 2013. A systematic review was performed to find other cases of pubic ramus fracture with severe bleeding from the literature.
  
  
  RESULTS
  Four elderly patients presented with severe bleeding following os pubis fracture after trivial falls from ground level. Successful arterial embolisation was performed in two cases. These patients were discharged in good clinical condition. Two other patients were refrained from further treatment due to a pre-existing poor prognosis. Twenty-two additional cases were found in the literature. Successful arterial embolisation was performed in 20 cases, of whom 17 survived.
  
  
  CONCLUSIONS
  Severe bleeding, mostly secondary to corona mortis avulsions, is a rare but potentially lethal complication of pubic ramus fractures. Physicians should be aware of this complication and actively look for symptoms of bleeding. Super-selective arterial embolisation seems safe and highly effective to control bleeding secondary to pubis rami fractures in elderly patients.
authors.affiliation: Department of Surgery, Ziekenhuis Gelderse Vallei, P.O. Box 9025, 6710 HN, Ede, The Netherlands. richard_tenbroek@hotmail.com.
authors.forename: R P G
authors.initials: RP
authors.lastname: Ten Broek
authors.affiliation: Department of Surgery, Ziekenhuis Gelderse Vallei, P.O. Box 9025, 6710 HN, Ede, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Bezemer
authors.affiliation: Department of Radiology, Ziekenhuis Gelderse Vallei, Ede, The Netherlands.
authors.forename: F A
authors.initials: FA
authors.lastname: Timmer
authors.affiliation: Department of Surgery, Ziekenhuis Gelderse Vallei, P.O. Box 9025, 6710 HN, Ede, The Netherlands.
authors.forename: R M H G
authors.initials: RM
authors.lastname: Mollen
authors.affiliation: Department of Surgery, Ziekenhuis Gelderse Vallei, P.O. Box 9025, 6710 HN, Ede, The Netherlands. BoekhoudtF@zgv.nl.
authors.forename: F D
authors.initials: FD
authors.lastname: Boekhoudt
keywords: Angiography; Fracture; Haemorrhage; Osteoporosis; Pubic bone
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