Current management of pelvic fractures: a combined surgical-angiographic approach to hemorrhage.

Pelvic retroperitoneal hemorrhage after pelvic fracture accounts for the high mortality and morbidity associated with this injury, a concept confirmed by analysis of 357 patients with pelvic fractures at the University of Kentucky Medical Center. The overall mortality of 9.8% was almost exclusively limited to patients with unstable fractures or crush injuries. The reliability of diagnostic peritoneal lavage in excluding associated intraperitoneal injury and the recognized utility of angiographic methods in identifying the site of bleeding constitute a major advance in management. Prompt angiographic definition of injury to major arterial trunks can lead to early operative intervention for direct vascular control. Bleeding from branches of the hypogastric artery can be managed effectively by clot embolization technic, avoiding operation. Venous bleeding is best treated by tamponade in most cases.