Huittinen V, Slatis P, Helsinki, Finland; Postmortem angiography and dissection of the hypogastric artery in pelvic fractures; Surgery 73:3 pp. 454-462, 1978
"Attention is drawn to the extensive injury in the posterior pelvic ring demonstrated in the dissections and to the importance of the fractured cancellous bone as a source of bleeding."
In 27 accident victims with fractures of the pelvis, dissection of the injured area and selective arteriography of the hypogastric arteries was done. The skeletal injury affected the anterior pelvic ring in all specimens, and the posterior weight-bearing area in 26. Extravasation from the hypogastric artery through the cancellous bone and torn tissues was visible in 23 arteriographic studies. The leakage was unilateral in six, bilateral in 17, and multiple in 14 specimens. Extravasation of the contrast medium occurred in all cases in the posterior pelvic area in close vicinity to the skeletal injury of the posterior pelvic ring, and, in an additional six patients, into the pelvic floor. The hemorrhage observed in connection with fractures of the sacrum, the sacroiliac region, and lesions of the pelvic floor are analyzed and the sources of bleeding are discussed accordingly. Attention is drawn to the extensive injury in the posterior pelvic ring demonstrated in the dissections and to the importance of the fractured cancellous bone as a source of bleeding. The observations indicate that accurate reposition of the dislocated pelvic fracture is preferable to ligation of the hypogastric arteries for control of severe hemorrhage from pelvic fractures.
From the Institute of Forensic Medicine, University of Helsinki, Helsinki, and the Surgical Department, Vaasa Central Hospital, Vaasa, Finland
FURTHER EXCERPTS:
In only 8/27 cases was the pelvic injury considered to be the main cause of
death.
The common iliac and external iliac arteries were ligated. Between these
ligatures, a thin polyethylene catheter was introduced into the hypogastric artery, through
which the vessel was washed serveral times with warm water. A gelatin-containing contrast
medium suitable for the examination of cadavers was employed and 40 cc of contrast medium,
warmed to 70 deg C, was injected through the catheter at a presure of 110 mm Hg. Identical
procedures were followed on both sides and radiographs of the contrast-filled specimen were
taken.
After the gelatin in the contrast material had congealed, the pelvic viscera
were removed. During the dissection, every endeavor was made to identify the arterial injuries
and to expose all coexistent skeletal lesions in the pelvic girdle.
The aim of the careful dissection was to clarify the anatomical site of the
arterial injury. This proved to be exceeedingly difficult however, and in only 3 patients (out
of a total of 27) could a lesion to a main artery be identified; two ruptures of the obturator
artery and one rupture of the hypogastric artery at their sites of origin. In the other
patients, in whom the main stems of the arteries remained intact, extravasation of the
congealed contrast medium both from the fractured cancellous bone and from the torn vessels in
adjacent soft tissue hampered identification of the various arteries involved.