Critical review of pelvic fractures associated with external iliac artery lesion: A series of six cases
Abstract Introduction Bleeding associated with pelvic fracture mostly comes from the pre-sacral and lumbar venous plexus, or directly from the fracture site. Bleeding as a consequence of arterial lesion is less common (15–20%), and that resulting from lesion of the external iliac artery (EIA) is ext...
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| Veröffentlicht in: | Injury 2014-02, Vol.45 (2), p.374-378 |
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| description | Abstract Introduction Bleeding associated with pelvic fracture mostly comes from the pre-sacral and lumbar venous plexus, or directly from the fracture site. Bleeding as a consequence of arterial lesion is less common (15–20%), and that resulting from lesion of the external iliac artery (EIA) is extremely rare. The mortality rate associated with iliac artery injury ranges from 38% to 72%. Total body CT-scan with contrast medium, angiography or packing can be performed when there is arterial injury. In some cases, embolisation can stop bleeding; however, when there is involvement of the aorta, common iliac artery or EIA, immediate surgery is mandatory. The aim of this study was to report our experience of pelvic fractures associated with EIA lesion. Materials and methods Six patients with pelvic fracture and associated rupture of the EIA have been observed at our unit from 2004 to 2009. According to Tile classification there were three cases of type C and two cases of type B fracture. One case was a two-column acetabular fracture. Angiography was performed in all cases. Results Three patients died on the day of trauma: two after angiography, and one after surgery of vascular repair. Three patients survived: two underwent a hemipelvectomy, and one underwent hip disarticulation. Discussion Haemodynamic instability in patients with pelvic ring fracture is usually because of venous bleeding from the pre-sacral and lumbar plexus, or from the fracture site. Arterial injury is present in around 20% of cases. EIA lesions require immediate surgical treatment to restore blood flow. Depending on the type of injury, vascular surgery can be associated with pelvic fracture stabilisation. Conclusions Pelvic ring fracture associated with an EIA lesion is extremely rare, with few cases reported in the literature. Angiography is used for diagnosis, and immediate surgical treatment is required to restore blood flow. Associated injuries and open fracture can lead to fatal complications or amputation. Rates of mortality and severe disability are extremely high. |
| doi_str_mv | 10.1016/j.injury.2013.10.011 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1490719240</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0020138313004750</els_id><sourcerecordid>1490719240</sourcerecordid><originalsourceid>FETCH-LOGICAL-c417t-bf128f8fd7cfa2c88683da45d471105ca38d21d492549c6e651899543199ae413</originalsourceid><addsrcrecordid>eNqFkUFv1DAQhS0EotvCP0DIRy5ZZmwnsTkgVatCkSpxAM6Wa0_AIZssdtJ2_z2OtnDgwsny6L03mu8x9gphi4DN234bx35Jx60AlGW0BcQnbIO6NRWIpn3KNgACKpRanrHznHsAbEHK5-xMKNRSGrVh33cpztG7gSe6i3TPp44faLiLnnfJ-XlJlLnLefLRzRT4fZx_cHqYKY3FE4foPHepfI98oByn8R2_5JlSLLYSleMD9y5TfsGedW7I9PLxvWDfPlx93V1XN58_ftpd3lReYTtXtx0K3ekutL5zwmvdaBmcqoNqEaH2TuogMCgjamV8Q02N2phaSTTGkUJ5wd6ccg9p-rVQnu0-Zk_D4EaalmxRGWjRCAVFqk5Sn6acE3X2kOLepaNFsCti29sTYrsiXqcFcbG9ftyw3O4p_DX9YVoE708CKncWpslmH2n0FGIiP9swxf9t-DfAD3FcS_pJR8r9tKzwyy02Cwv2y1rz2jJKANXWIH8DpuWj3Q</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1490719240</pqid></control><display><type>article</type><title>Critical review of pelvic fractures associated with external iliac artery lesion: A series of six cases</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><creator>Pascarella, Raffaele ; Del Torto, Michele ; Politano, Rocco ; Commessatti, Matteo ; Fantasia, Rossana ; Maresca, Alessandra</creator><creatorcontrib>Pascarella, Raffaele ; Del Torto, Michele ; Politano, Rocco ; Commessatti, Matteo ; Fantasia, Rossana ; Maresca, Alessandra</creatorcontrib><description>Abstract Introduction Bleeding associated with pelvic fracture mostly comes from the pre-sacral and lumbar venous plexus, or directly from the fracture site. Bleeding as a consequence of arterial lesion is less common (15–20%), and that resulting from lesion of the external iliac artery (EIA) is extremely rare. The mortality rate associated with iliac artery injury ranges from 38% to 72%. Total body CT-scan with contrast medium, angiography or packing can be performed when there is arterial injury. In some cases, embolisation can stop bleeding; however, when there is involvement of the aorta, common iliac artery or EIA, immediate surgery is mandatory. The aim of this study was to report our experience of pelvic fractures associated with EIA lesion. Materials and methods Six patients with pelvic fracture and associated rupture of the EIA have been observed at our unit from 2004 to 2009. According to Tile classification there were three cases of type C and two cases of type B fracture. One case was a two-column acetabular fracture. Angiography was performed in all cases. Results Three patients died on the day of trauma: two after angiography, and one after surgery of vascular repair. Three patients survived: two underwent a hemipelvectomy, and one underwent hip disarticulation. Discussion Haemodynamic instability in patients with pelvic ring fracture is usually because of venous bleeding from the pre-sacral and lumbar plexus, or from the fracture site. Arterial injury is present in around 20% of cases. EIA lesions require immediate surgical treatment to restore blood flow. Depending on the type of injury, vascular surgery can be associated with pelvic fracture stabilisation. Conclusions Pelvic ring fracture associated with an EIA lesion is extremely rare, with few cases reported in the literature. Angiography is used for diagnosis, and immediate surgical treatment is required to restore blood flow. Associated injuries and open fracture can lead to fatal complications or amputation. Rates of mortality and severe disability are extremely high.</description><identifier>ISSN: 0020-1383</identifier><identifier>EISSN: 1879-0267</identifier><identifier>DOI: 10.1016/j.injury.2013.10.011</identifier><identifier>PMID: 24183394</identifier><language>eng</language><publisher>Netherlands: Elsevier Ltd</publisher><subject>Abdominal Injuries - diagnostic imaging ; Abdominal Injuries - mortality ; Abdominal Injuries - surgery ; Accidents, Traffic ; Acetabular ; Adult ; Angiography ; Blood Transfusion ; External iliac artery ; Female ; Fractures, Bone - surgery ; Haemorrhage ; Hemorrhage - diagnostic imaging ; Hemorrhage - etiology ; Hemorrhage - surgery ; Humans ; Iliac Artery - diagnostic imaging ; Iliac Artery - injuries ; Iliac Artery - surgery ; Injury Severity Score ; Male ; Middle Aged ; Orthopedics ; Pelvic Bones - diagnostic imaging ; Pelvic Bones - injuries ; Pelvic Bones - surgery ; Pelvic fractures ; Rupture ; Tomography, X-Ray Computed - methods ; Treatment Outcome ; Vascular System Injuries - diagnostic imaging ; Vascular System Injuries - mortality ; Vascular System Injuries - surgery</subject><ispartof>Injury, 2014-02, Vol.45 (2), p.374-378</ispartof><rights>Elsevier Ltd</rights><rights>2013 Elsevier Ltd</rights><rights>Copyright © 2013 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c417t-bf128f8fd7cfa2c88683da45d471105ca38d21d492549c6e651899543199ae413</citedby><cites>FETCH-LOGICAL-c417t-bf128f8fd7cfa2c88683da45d471105ca38d21d492549c6e651899543199ae413</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.injury.2013.10.011$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24183394$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pascarella, Raffaele</creatorcontrib><creatorcontrib>Del Torto, Michele</creatorcontrib><creatorcontrib>Politano, Rocco</creatorcontrib><creatorcontrib>Commessatti, Matteo</creatorcontrib><creatorcontrib>Fantasia, Rossana</creatorcontrib><creatorcontrib>Maresca, Alessandra</creatorcontrib><title>Critical review of pelvic fractures associated with external iliac artery lesion: A series of six cases</title><title>Injury</title><addtitle>Injury</addtitle><description>Abstract Introduction Bleeding associated with pelvic fracture mostly comes from the pre-sacral and lumbar venous plexus, or directly from the fracture site. Bleeding as a consequence of arterial lesion is less common (15–20%), and that resulting from lesion of the external iliac artery (EIA) is extremely rare. The mortality rate associated with iliac artery injury ranges from 38% to 72%. Total body CT-scan with contrast medium, angiography or packing can be performed when there is arterial injury. In some cases, embolisation can stop bleeding; however, when there is involvement of the aorta, common iliac artery or EIA, immediate surgery is mandatory. The aim of this study was to report our experience of pelvic fractures associated with EIA lesion. Materials and methods Six patients with pelvic fracture and associated rupture of the EIA have been observed at our unit from 2004 to 2009. According to Tile classification there were three cases of type C and two cases of type B fracture. One case was a two-column acetabular fracture. Angiography was performed in all cases. Results Three patients died on the day of trauma: two after angiography, and one after surgery of vascular repair. Three patients survived: two underwent a hemipelvectomy, and one underwent hip disarticulation. Discussion Haemodynamic instability in patients with pelvic ring fracture is usually because of venous bleeding from the pre-sacral and lumbar plexus, or from the fracture site. Arterial injury is present in around 20% of cases. EIA lesions require immediate surgical treatment to restore blood flow. Depending on the type of injury, vascular surgery can be associated with pelvic fracture stabilisation. Conclusions Pelvic ring fracture associated with an EIA lesion is extremely rare, with few cases reported in the literature. Angiography is used for diagnosis, and immediate surgical treatment is required to restore blood flow. Associated injuries and open fracture can lead to fatal complications or amputation. Rates of mortality and severe disability are extremely high.</description><subject>Abdominal Injuries - diagnostic imaging</subject><subject>Abdominal Injuries - mortality</subject><subject>Abdominal Injuries - surgery</subject><subject>Accidents, Traffic</subject><subject>Acetabular</subject><subject>Adult</subject><subject>Angiography</subject><subject>Blood Transfusion</subject><subject>External iliac artery</subject><subject>Female</subject><subject>Fractures, Bone - surgery</subject><subject>Haemorrhage</subject><subject>Hemorrhage - diagnostic imaging</subject><subject>Hemorrhage - etiology</subject><subject>Hemorrhage - surgery</subject><subject>Humans</subject><subject>Iliac Artery - diagnostic imaging</subject><subject>Iliac Artery - injuries</subject><subject>Iliac Artery - surgery</subject><subject>Injury Severity Score</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Orthopedics</subject><subject>Pelvic Bones - diagnostic imaging</subject><subject>Pelvic Bones - injuries</subject><subject>Pelvic Bones - surgery</subject><subject>Pelvic fractures</subject><subject>Rupture</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>Treatment Outcome</subject><subject>Vascular System Injuries - diagnostic imaging</subject><subject>Vascular System Injuries - mortality</subject><subject>Vascular System Injuries - surgery</subject><issn>0020-1383</issn><issn>1879-0267</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUFv1DAQhS0EotvCP0DIRy5ZZmwnsTkgVatCkSpxAM6Wa0_AIZssdtJ2_z2OtnDgwsny6L03mu8x9gphi4DN234bx35Jx60AlGW0BcQnbIO6NRWIpn3KNgACKpRanrHznHsAbEHK5-xMKNRSGrVh33cpztG7gSe6i3TPp44faLiLnnfJ-XlJlLnLefLRzRT4fZx_cHqYKY3FE4foPHepfI98oByn8R2_5JlSLLYSleMD9y5TfsGedW7I9PLxvWDfPlx93V1XN58_ftpd3lReYTtXtx0K3ekutL5zwmvdaBmcqoNqEaH2TuogMCgjamV8Q02N2phaSTTGkUJ5wd6ccg9p-rVQnu0-Zk_D4EaalmxRGWjRCAVFqk5Sn6acE3X2kOLepaNFsCti29sTYrsiXqcFcbG9ftyw3O4p_DX9YVoE708CKncWpslmH2n0FGIiP9swxf9t-DfAD3FcS_pJR8r9tKzwyy02Cwv2y1rz2jJKANXWIH8DpuWj3Q</recordid><startdate>20140201</startdate><enddate>20140201</enddate><creator>Pascarella, Raffaele</creator><creator>Del Torto, Michele</creator><creator>Politano, Rocco</creator><creator>Commessatti, Matteo</creator><creator>Fantasia, Rossana</creator><creator>Maresca, Alessandra</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140201</creationdate><title>Critical review of pelvic fractures associated with external iliac artery lesion: A series of six cases</title><author>Pascarella, Raffaele ; Del Torto, Michele ; Politano, Rocco ; Commessatti, Matteo ; Fantasia, Rossana ; Maresca, Alessandra</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c417t-bf128f8fd7cfa2c88683da45d471105ca38d21d492549c6e651899543199ae413</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Abdominal Injuries - diagnostic imaging</topic><topic>Abdominal Injuries - mortality</topic><topic>Abdominal Injuries - surgery</topic><topic>Accidents, Traffic</topic><topic>Acetabular</topic><topic>Adult</topic><topic>Angiography</topic><topic>Blood Transfusion</topic><topic>External iliac artery</topic><topic>Female</topic><topic>Fractures, Bone - surgery</topic><topic>Haemorrhage</topic><topic>Hemorrhage - diagnostic imaging</topic><topic>Hemorrhage - etiology</topic><topic>Hemorrhage - surgery</topic><topic>Humans</topic><topic>Iliac Artery - diagnostic imaging</topic><topic>Iliac Artery - injuries</topic><topic>Iliac Artery - surgery</topic><topic>Injury Severity Score</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Orthopedics</topic><topic>Pelvic Bones - diagnostic imaging</topic><topic>Pelvic Bones - injuries</topic><topic>Pelvic Bones - surgery</topic><topic>Pelvic fractures</topic><topic>Rupture</topic><topic>Tomography, X-Ray Computed - methods</topic><topic>Treatment Outcome</topic><topic>Vascular System Injuries - diagnostic imaging</topic><topic>Vascular System Injuries - mortality</topic><topic>Vascular System Injuries - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pascarella, Raffaele</creatorcontrib><creatorcontrib>Del Torto, Michele</creatorcontrib><creatorcontrib>Politano, Rocco</creatorcontrib><creatorcontrib>Commessatti, Matteo</creatorcontrib><creatorcontrib>Fantasia, Rossana</creatorcontrib><creatorcontrib>Maresca, Alessandra</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Injury</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pascarella, Raffaele</au><au>Del Torto, Michele</au><au>Politano, Rocco</au><au>Commessatti, Matteo</au><au>Fantasia, Rossana</au><au>Maresca, Alessandra</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Critical review of pelvic fractures associated with external iliac artery lesion: A series of six cases</atitle><jtitle>Injury</jtitle><addtitle>Injury</addtitle><date>2014-02-01</date><risdate>2014</risdate><volume>45</volume><issue>2</issue><spage>374</spage><epage>378</epage><pages>374-378</pages><issn>0020-1383</issn><eissn>1879-0267</eissn><abstract>Abstract Introduction Bleeding associated with pelvic fracture mostly comes from the pre-sacral and lumbar venous plexus, or directly from the fracture site. Bleeding as a consequence of arterial lesion is less common (15–20%), and that resulting from lesion of the external iliac artery (EIA) is extremely rare. The mortality rate associated with iliac artery injury ranges from 38% to 72%. Total body CT-scan with contrast medium, angiography or packing can be performed when there is arterial injury. In some cases, embolisation can stop bleeding; however, when there is involvement of the aorta, common iliac artery or EIA, immediate surgery is mandatory. The aim of this study was to report our experience of pelvic fractures associated with EIA lesion. Materials and methods Six patients with pelvic fracture and associated rupture of the EIA have been observed at our unit from 2004 to 2009. According to Tile classification there were three cases of type C and two cases of type B fracture. One case was a two-column acetabular fracture. Angiography was performed in all cases. Results Three patients died on the day of trauma: two after angiography, and one after surgery of vascular repair. Three patients survived: two underwent a hemipelvectomy, and one underwent hip disarticulation. Discussion Haemodynamic instability in patients with pelvic ring fracture is usually because of venous bleeding from the pre-sacral and lumbar plexus, or from the fracture site. Arterial injury is present in around 20% of cases. EIA lesions require immediate surgical treatment to restore blood flow. Depending on the type of injury, vascular surgery can be associated with pelvic fracture stabilisation. Conclusions Pelvic ring fracture associated with an EIA lesion is extremely rare, with few cases reported in the literature. Angiography is used for diagnosis, and immediate surgical treatment is required to restore blood flow. Associated injuries and open fracture can lead to fatal complications or amputation. Rates of mortality and severe disability are extremely high.</abstract><cop>Netherlands</cop><pub>Elsevier Ltd</pub><pmid>24183394</pmid><doi>10.1016/j.injury.2013.10.011</doi><tpages>5</tpages></addata></record> |
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| subjects | Abdominal Injuries - diagnostic imaging Abdominal Injuries - mortality Abdominal Injuries - surgery Accidents, Traffic Acetabular Adult Angiography Blood Transfusion External iliac artery Female Fractures, Bone - surgery Haemorrhage Hemorrhage - diagnostic imaging Hemorrhage - etiology Hemorrhage - surgery Humans Iliac Artery - diagnostic imaging Iliac Artery - injuries Iliac Artery - surgery Injury Severity Score Male Middle Aged Orthopedics Pelvic Bones - diagnostic imaging Pelvic Bones - injuries Pelvic Bones - surgery Pelvic fractures Rupture Tomography, X-Ray Computed - methods Treatment Outcome Vascular System Injuries - diagnostic imaging Vascular System Injuries - mortality Vascular System Injuries - surgery |
| title | Critical review of pelvic fractures associated with external iliac artery lesion: A series of six cases |
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