J Cardiovasc Surg
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To establish the frequency of major vascular trauma, facilitate recognition of potential injury based on fracture pattern, and formulate a systematic approach to evaluation and management, we studied 429 consecutive patients with acute blunt pelvic fracture. Fracture patterns were grouped as non-ring brakes (n = 43), anterior pelvic ring (n = 197), posterior pelvic ring (n = 104), or acetabular (n = 85) involvement. Mean age was 31 (range 2 to 90); 55% were male. ⋯ Posterior ring disruption was associated with vascular injury requiring intervention (p less than 0.001). The occurrence of associated injuries (p less than 0.001), need of greater than 10 units of blood transfusion in the first 24 hours (p less than 0.005), and death (p less than 0.01) were consequences of posterior ring disruption. Based on this experience we conclude that: (1) aortoiliac and femoral arterial as well as iliofemoral venous injuries are a very rare consequence of pelvic fracture; (2) pelvic fracture with posterior ring disruption has a higher incidence of vascular injury necessitating intervention, associated injury, major transfusion requirement, and death; (3) early interventional radiology is efficacious in the control of arterial disruption caused by pelvic fracture; and (4) a tailored management strategy using the expertise of the vascular and orthopedic surgeon as well as the radiologist is required for recalcitrant hemorrhage.