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Pelvis

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Essential Interventional Radiology Review

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Abstract

Initial management of extremity trauma should focus on control of bleeding and pelvic fixation/splinting of obvious fractures, followed by the evaluation and stabilization of the ABCs and resuscitation efforts as necessary after arrival to the hospital. CT pelvis with IV contrast is ideal for the localization of active pelvic bleeding, as it can also evaluate for expanding hematomas, fractures, and other injuries to the bowel and bladder. The four main categories of pelvic fractures include lateral compression, anterior-posterior compression, vertical shear, and combined, with prototypical trauma mechanisms and associated vascular injury patterns for each. Patients who are hemodynamically unstable despite resuscitation with imaging findings of intraperitoneal hemorrhage and hard signs of vascular injury should undergo emergent surgical exploration and repair. Patients who remain hemodynamically unstable after intra-abdominal injuries have been ruled out and despite pelvic fixation should undergo emergent pelvic arteriography with embolization, as should patients who are hemodynamically stable with findings of continued pelvic bleeding.

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Further Reading

  • Abrassart S, Stern R, Peter R. Unstable pelvic ring injury with hemodynamic instability: what seems the best procedure choice and sequence in the initial management? Orthop Traumatol Surg Res. 2013;99(2):175–82.

    Article  CAS  PubMed  Google Scholar 

  • Alton TB, Gee AO. Classifications in brief: young and burgess classification of pelvic ring injuries. Clin Orthop Relat Res. 2014;472(8):2338–42.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ayella RJ, DuPriest RW Jr, Khaneja SC, Maekawa K, Soderstrom CA, Rodriguez A, et al. Transcatheter embolization of autologous clot in the management of bleeding associated with fractures of the pelvis. Surg Gynecol Obstet. 1978;147(6):849–52.

    CAS  PubMed  Google Scholar 

  • Ben-Menachem Y, Coldwell DM, Young JW, Burgess AR. Hemorrhage associated with pelvic fractures: causes, diagnosis, and emergent management. AJR Am J Roentgenol. 1991;157(5):1005–14.

    Article  CAS  PubMed  Google Scholar 

  • Coccolini F, Stahel PF, Montori G, Biffl W, Horer TM, Catena F, et al. Pelvic trauma: WSES classification and guidelines. World J Emerg Surg. 2017;12:5.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cullinane DC, Schiller HJ, Zielinski MD, Bilaniuk JW, Collier BR, Como J, et al. Eastern Association for the Surgery of trauma practice management guidelines for hemorrhage in pelvic fracture--update and systematic review. J Trauma. 2011;71(6):1850–68.

    PubMed  Google Scholar 

  • Fox N, Rajani RR, Bokhari F, Chiu WC, Kerwin A, Seamon MJ, et al. Evaluation and management of penetrating lower extremity arterial trauma: an Eastern Association for the Surgery of trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S315–20.

    Article  PubMed  Google Scholar 

  • Halawi MJ. Pelvic ring injuries: emergency assessment and management. J Clin Orthop Trauma. 2015;6(4):252–8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Halawi MJ. Pelvic ring injuries: surgical management and long-term outcomes. J Clin Orthop Trauma. 2016;7(1):1–6.

    Article  PubMed  Google Scholar 

  • Hussami M, Grabherr S, Meuli RA, Schmidt S. Severe pelvic injury: vascular lesions detected by ante- and post-mortem contrast medium-enhanced CT and associations with pelvic fractures. Int J Legal Med. 2017;131(3):731–8.

    Article  PubMed  Google Scholar 

  • Ierardi AM, Duka E, Lucchina N, Floridi C, De Martino A, Donat D, et al. The role of interventional radiology in abdominopelvic trauma. Br J Radiol. 2016;89(1061):20150866.

    Article  PubMed  PubMed Central  Google Scholar 

  • Juern JS, Milia D, Codner P, Beckman M, Somberg L, Webb T, et al. Clinical significance of computed tomography contrast extravasation in blunt trauma patients with a pelvic fracture. J Trauma Acute Care Surg. 2017;82(1):138–40.

    Article  PubMed  Google Scholar 

  • Karadimas EJ, Nicolson T, Kakagia DD, Matthews SJ, Richards PJ, Giannoudis PV. Angiographic embolisation of pelvic ring injuries. Treatment algorithm and review of the literature. Int Orthop. 2011;35(9):1381–90.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kaufman JA. Abdominal aorta and pelvic arteries. In: Kaufman JA, Lee MJ, editors. The requisites: vascular and interventional radiology. 2nd ed. Philadelphia: Saunders Elsevier; 2014. p. 199–228.

    Google Scholar 

  • Kaufman JA. Fundamentals of angiography. In: Kaufman JA, Lee MJ, editors. The requisites: vascular and interventional radiology. 2nd ed. Philadelphia: Saunders Elsevier; 2014. p. 25–55.

    Google Scholar 

  • Kaufman JA. Vascular interventions. In: Kaufman JA, Lee MJ, editors. The requisites: vascular and interventional radiology. 2nd ed. Philadelphia: Saunders Elsevier; 2014. p. 68–98.

    Google Scholar 

  • Kaufman JA. Vascular pathology. In: Kaufman JA, Lee MJ, editors. The requisites: vascular and interventional radiology. 2nd ed. Philadelphia: Saunders Elsevier; 2014. p. 1–24.

    Google Scholar 

  • Kerr WS Jr, Margolies MN, Ring EJ, Waltman AC, Baum SN. Arteriography in pelvic fractures with massive hemorrhage. J Urol. 1973;109(3):479–82.

    Article  PubMed  Google Scholar 

  • Kim PH, Leopold SS. In brief: Gustilo-Anderson classification. [corrected]. Clin Orthop Relat Res. 2012;470(11):3270–4.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kimbrell BJ, Velmahos GC, Chan LS, Demetriades D. Angiographic embolization for pelvic fractures in older patients. Arch Surg (Chicago, Ill : 1960). 2004;139(7):728–32. discussion 32-3

    Google Scholar 

  • Margolies MN, Ring EJ, Waltman AC, Kerr WS Jr, Baum S. Arteriography in the management of hemorrhage from pelvic fractures. N Engl J Med. 1972;287(7):317–21.

    Article  CAS  PubMed  Google Scholar 

  • Marzi I, Lustenberger T. Management of Bleeding Pelvic Fractures. Scandinavian J Surg. 2014;103(2):104–11.

    Article  CAS  Google Scholar 

  • Matalon TS, Athanasoulis CA, Margolies MN, Waltman AC, Novelline RA, Greenfield AJ, et al. Hemorrhage with pelvic fractures: efficacy of transcatheter embolization. AJR Am J Roentgenol. 1979;133(5):859–64.

    Article  CAS  PubMed  Google Scholar 

  • Nelson KJ, Mitchell D. Visceral and solid organ trauma. In: Keefe NA, Haskal ZJ, Park AW, Angle JF, editors. In: IR playbook. 1st ed. New York: Springer; 2018. p. 357–69.

    Chapter  Google Scholar 

  • Padia SA, et al. Society of Interventional Radiology Position Statement on endovascular intervention for trauma. JVIR. 2020;31(3):363–9.

    Article  PubMed  Google Scholar 

  • Richard HM. Pelvic and extremity trauma. In: Keefe NA, Haskal ZJ, Park AW, Angle JF, editors. IR Playbook. 1st ed. New York: Springer; 2018. p. 371–7.

    Chapter  Google Scholar 

  • Ring EJ, Athanasoulis C, Waltman AC, Margolies MN, Baum S. Arteriographic management of hemorrhage following pelvic fracture. Radiology. 1973;109(1):65–70.

    Article  CAS  PubMed  Google Scholar 

  • Roberts DJ, Bobrovitz N, Zygun DA, Ball CG, Kirkpatrick AW, Faris PD, et al. Indications for use of thoracic, abdominal, pelvic, and vascular damage control interventions in trauma patients: a content analysis and expert appropriateness rating study. J Trauma Acute Care Surg. 2015;79(4):568–79.

    Article  PubMed  Google Scholar 

  • Scemama U, Dabadie A, Varoquaux A, Soussan J, Gaudon C, Louis G, et al. Pelvic trauma and vascular emergencies. Diagn Interv Imaging. 2015;96(7-8):717–29.

    Article  CAS  PubMed  Google Scholar 

  • Shi J, Gomes A, Lee E, Kee S, Moriarty J, Cryer H, et al. Complications after transcatheter arterial embolization for pelvic trauma: relationship to level and laterality of embolization. Eur J Orthop Surg Traumatol orthopedie traumatologie. 2016;26(8):877–83.

    Article  PubMed  Google Scholar 

  • Taylor RM, Sullivan MP, Mehta S. Acute compartment syndrome: obtaining diagnosis, providing treatment, and minimizing medicolegal risk. Curr Rev Musculoskelet Med. 2012;5(3):206–13.

    Article  PubMed  PubMed Central  Google Scholar 

  • Venkatesan AM, Kundu S, Sacks D, Wallace MJ, Wojak JC, Rose SC, et al. Practice guidelines for adult antibiotic prophylaxis during vascular and interventional radiology procedures. Written by the Standards of Practice Committee for the Society of Interventional Radiology and Endorsed by the Cardiovascular Interventional Radiological Society of Europe and Canadian Interventional Radiology Association [corrected]. J Vasc Interv Radiol. 2010;21(11):1611–30; quiz 31.

    Google Scholar 

  • Walker ML. The damage control laparotomy. J Natl Med Assoc. 1995;87(2):119–22.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Wong JJ, Roberts AC. Embolization and pelvic trauma. In: Golzarian J, Sun S, Sharafuddin MJ, editors. Vascular embolotherapy: a comprehensive approach. New York: Springer; 2006. p. 59–68.

    Chapter  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Interventional Radiology, Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA

    Justin J. Guan

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  1. Justin J. Guan
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Editors and Affiliations

  1. The Hospital for Sick Children, Toronto, Ontario, ON, Canada

    Rajat Chand

  2. Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Adam E. M. Eltorai

  3. Brown University, East Providence, RI, USA

    Terrance Healey

  4. Brown University, Providence, RI, USA

    Sun Ahn

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Guan, J.J. (2022). Pelvis. In: Chand, R., Eltorai, A.E.M., Healey, T., Ahn, S. (eds) Essential Interventional Radiology Review. Springer, Cham. https://doi.org/10.1007/978-3-030-84172-0_48

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  • DOI: https://doi.org/10.1007/978-3-030-84172-0_48

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-84171-3

  • Online ISBN: 978-3-030-84172-0

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