Multiple pelvic fractures and muscular hematoma in a case of multitrauma
Presentation
This 71 yo female was a rear seat passenger in a motor vehicle accident. The car was turning and hit by another car at 80 km/hr, with the patient's car overturning. The patient described no loss of consciousness. She described left hip pain.
Patient Data
- Multiple pelvic fractures present with associated large left anterior pelvis hematoma and active hemorrhage demonstrated in the anterior left pelvis and posterior left pelvis.
- Right quadriceps muscle hematoma with active hemorrhage.
- Left adductor muscle group hematoma with active hemorrhage.
Case Discussion
Muscle hematoma commonly occurs after blunt trauma, however usually in the sports setting1. High impact pressures disrupt muscular vasculature, and this can cause build up of blood or a hematoma.
Particular attention needs to be paid to ensure that there the hematoma does not cause compartment syndrome. Compartment syndrome is a condition where increased pressure within an osseofascial compartment exceeds the systolic blood pressure. If left untreated, this causes decreased perfusion and resulting ischemia and necrosis. Definitive management for compartment syndrome consists of a fasciotomy which relieves the pressure within the muscle compartment, restoring blood flow to the limbs.
Comminuted pelvic fractures are associated with blunt trauma - classically high speed motor vehicle accidents, however falls from buildings are also implicated2. Pelvic fractures can be life threatening because they are associated with retroperitoneal hematoma and hemorrhagic shock.
Definitive management of haemodynamically unstable patients with pelvic fractures involves either surgical fixation and surgery or radiological arterio-embolization to reduce hemorrhage.
Case contributed by A/Prof. Pramit Phal.
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