Can the Sacral Spongiosa Bleeding Cause Fatal Complications of Unstable Pelvic Fracture?

Česká verzia

Authors: V. Džupa; L. Horák ¹; E. Gavulová ²; J. Málek ³
Authors place of work: Ortopedicko-traumatologická klinika 3. LF UK a FN Královské Vinohrady, Praha přednosta: doc. MUDr. Martin Krbec, CSc. ; Chirurgická klinika 3. LF UK a FN Královské Vinohrady, Praha, přednosta: prof. MUDr. Robert Gürlich, CSc. ¹; Klinika anesteziologie a resuscitace 2. LF UK a FN Motol, Praha přednosta: prof. MUDr. Karel Cvachovec, CSc. ²; Klinika anesteziologie a resuscitace 3. LF UK a FN Královské Vinohrady, Praha přednosta: prof. MUDr. Jan Pachl, CSc. ³
Published in the journal: Rozhl. Chir., 2009, roč. 88, č. 12, s. 699-703.
Category: Monothematic special - Original

Summary

The authors present the case of 36 years old woman, who suffered from unstable fracture of pelvis after she fell from the 5th floor. The spongiosa bleeding from both massae laterales sacri caused significant blood circuit destabilisation not only immediately after the injury but also in hours following the external fixation of pelvis. Due to persistent blood losses it was necessary to apply 38 RBC units, 48 FFP units, 1500 IU of antithrombin III, 1000 mg of fibrinogen and 6 platelet units within first 12 hospitalisation hours. With respect to ongoing bleeding and lack of accessible blood products it was decided to stop intensive hemotherapy and rationalize the treatment.

The rationalization led to the hypotension (systolic blood pressure was 40–60 mm Hg), which along with gradual increase of body temperature caused unexpectable patient stabilisation. The systolic blood pressure was stabilized on 80 mm Hg and heart rate about 100/min. After 4 hours another 3 RBC units and 4 FFP units brought from the nearest reachable hospital were applied. The following blood pressure measurement was 120/80 and heart rate about 90/min. In the course of following 2 days it was possible to stop the catecholamine treatment.

The authors are of opinion, that uncovered spongiosa caused by expresive dislocation of fragments may lead to massive bleeding that is difficult to stop by accessible means. The bleeding may be an essential risk for patients life and neither targeted intensive postoperative care can settle the matter.

Key words:
pelvic injury – massive bleeding

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