J Korean Soc Radiol.  2012 Oct;67(4):277-284. 10.3348/jksr.2012.67.4.277.

Relationship of Pelvic Bone Fracture Pattern and Bleeding Foci on Angiography

• Lee HM
• Kim JH
• Byun SS
• Kim HS

• KMID: 1439541
• DOI: http://doi.org/10.3348/jksr.2012.67.4.277

Abstract

PURPOSE
The purpose of this study is to evaluate the relationship between the patterns of pelvic bone fracture and location of hemorrhage on angiography.
MATERIALS AND METHODS
We retrospectively reviewed 56 patients with pelvic bone fracture and active bleeding. Fractures were classified according to Tile classification. Locations of bleedings were divided into four groups; main trunk/anterior/posterior divisions of internal iliac artery, and other locations. The relationship between the fracture pattern and bleedings were analyzed statistically.
RESULTS
Forty-one bleedings were in 22 patients with type A fracture. Twenty (49%) were at the anterior division, 12 (29%) were at the posterior division, and 9 (22%) were found in other location. Thirty-three bleedings were in 23 patients with type B fracture. Fifteen (45%) were at the posterior division, 10 (30%) were at the anterior division, 3 (9%) were at the main trunk of the internal iliac artery, and 5 (16%) were at other location. Eighteen bleedings were in 11 patients with type C fracture. Thirteen (72%) were at the posterior division, 4 (22%) were at the anterior division, and 1 (6%) was at main trunk of internal iliac artery. Anterior divisional bleedings were more common in type A, posterior divisional bleedings were more common in type B and C fractures (p = 0.014).
CONCLUSION
The distribution of bleeding is significantly related to the fracture patterns. Fracture pattern may help in predicting the location of bleeding foci on embolization.

MeSH Terms

Angiography
Hemorrhage
Humans
Iliac Artery
Pelvic Bones
Retrospective Studies

Figure

• 

  Fig. 1 A 35-year-old male who has a compression injury on the lower abdomen. A. Conventional pelvic AP view shows minimally displaced pubic bone fracture (arrows) suggestive of type A fracture. B. Angiography shows contrast extravasation in the right obturator artery, a branch of the internal iliac artery anterior division (arrowhead). Note.-AP = anteroposterior

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  Fig. 2 An 18-year-old male who had an motorcycle accident. A, B. Conventional pelvic AP view and abdominopelvic CT shows fracture of the right pubic ramus and disrupted anterior margin of the left sacroiliac joint (arrows), suggestive of type B fracture. C. Angiography shows active bleeding at the left main internal iliac artery (arrowhead). Note.-AP = anteroposterior

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  Fig. 3 A 50-year-old female who was involved in a pedestrian-traffic accident. A, B. Conventional pelvic AP view and abdominopelvic CT shows complete disruption of the right sacroiliac joint with vertical and rotational instability, suggestive of type C fracture (arrows). C. Angiography shows active bleeding at the right superior gluteal artery, a branch of the internal iliac artery posterior division (arrowhead). Note.-AP = anteroposterior

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