Summary
In 42 patients, massive haemorrhage following comminuted pelvic fractures was treated by operation through a mid-line, Pfannenstiel, anterior iliac crest-femoral or posterolateral approach, or using these in combination. The superior and inferior gluteal, pudendal and obturator arteries were the usual source of bleeding. Bleeding from the pelvic bone tissue was of minor importance. Temporary compression of the abdominal aorta was sometimes required to help control bleeding before ligation of injured vessels could be accomplished. An average of nine units of blood was given to each patient before operation and 30 units during or after the procedure. Of the 12 deaths, only three were attributable to bleeding from the pelvic fractures, indicating the value of operation in the treatment of massive haemorrhage from such injuries.
Résumé
Chez 42 blessés, une hémorragie massive succédant à une fracture comminutive du bassin a été traitée chirurgicalement. La voie d'abord choisie a été soit une médiane, un Pfannenstiel, une sus-iliaque ou une postéro-latérale, soit une combinaison de plusieurs de ces voies. Les sources les plus fréquentes du saignement étaient les artères fessières, supérieure et inférieure, les honteuses et l'obturatrice, tandis que le saignement d'origine osseuse était de peu d'importance. La compression temporaire de l'aorte a été quelquefois nécessaire pour contrôler l'hémorragie avant que la ligature des vaisseaux rompus ait pu être réalisée. Neuf flacons de sang, en moyenne, ont été perfusés avant l'opération et trente pendant et après celle-ci. Des 12 morts, trois seulement peuvent être attribuées à l'hémorragie due à la fracture du bassin, ce qui démontre la valeur d'une intervention pour hémostase dans les traumatismes de ce type.
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Riska, E.B., von Bonsdorff, H., Hakkinen, S. et al. Operative control of massive haemorrhage in comminuted pelvic fractures. International Orthopaedics 3, 141–144 (1979). https://doi.org/10.1007/BF00266884
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DOI: https://doi.org/10.1007/BF00266884