J Korean Orthop Assoc.  2019 Dec;54(6):557-561. 10.4055/jkoa.2019.54.6.557.

Massive Hemorrhage Caused by a Non-Displaced Pubic Ramus Fracture from Low-Energy Trauma

• Na HY
• Shin KY
• Choe S

• KMID: 2469887
• DOI: http://doi.org/10.4055/jkoa.2019.54.6.557

Abstract

Most low-energy pelvic ring fractures in elderly patients are treated conservatively so that an initial evaluation for complications such as vascular injury is usually overlooked. An 81-year-old female, who was taking regular aspirin, visited the emergency room and was diagnosed with a simple non-displaced pubic ramus fracture from a low-energy fall from standing, which was complicated by massive hemorrhage from the overlooked injury of the corona mortis. Elderly patients with pelvic ring fractures can have a delayed presentation of vascular injuries, regardless of the degree of displacement of the fractures, which highlights the need for a careful physical examination and close monitoring.

Keyword

pelvic ring fracture; ramus fracture; corona mortis; massive hemorrhage; aspirin

MeSH Terms

Aged
Aged, 80 and over
Aspirin
Emergency Service, Hospital
Female
Hemorrhage*
Humans
Physical Examination
Vascular System Injuries
Aspirin

Figure

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  Figure 1 Anteroposterior pelvic radiograph showing a non-displaced left superior and inferior pubic ramus fracture without a posterior pelvic ring injury (arrows).

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  Figure 2 Axial pelvic bone computed tomography scan showing a non-displaced left superior (arrow) (A) and inferior (arrow) (B) pubic ramus fracture. No sacral fracture or sacroiliac joint widening was observed.

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  Figure 3 Contrast-enhanced axial pelvic computed tomography scan showing an active contrast extravasation adjacent fracture site (arrow). An approximately 12-cm-sized hematoma in the extraperitoneal space of left pelvic wall is seen.

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  Figure 4 Pelvic angiography with a left internal iliac angiogram showing active extravasation of contrast media from the corona mortis near the left pubic body fracture site (arrows).

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  Figure 5 No active arterial bleeding was observed on the left internal iliac angiogram after successful embolization of the corona mortis (arrows).

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