Angioembolization for geriatric stable pelvic fracture with active bleeding—the possibility of massive hemorrhage due to corona mortis

Pelvic hemorrhage is a major cause of mortality in polytrauma patients with pelvic fractures. However, studies on stable pelvic fracture and corona mortis requiring angioembolization (AE) are limited. This study aimed to elucidate the characteristics of patients with stable pelvic fractures requiring AE and describe the findings related to corona mortis involvement leading to large pelvic hematomas. We conducted a retrospective observational study in a level-one trauma center between 2018 and 2023. We included patients who underwent AE for traumatic pelvic hemorrhage, as indicated by an initial computed tomography (CT) scan. Patients with unstable pelvic fractures and negative AE findings were excluded. Demographics, fracture details, arteries targeted for embolization, and the presence of corona mortis and huge pelvic hematoma (hematoma rim distance exceeding 5 cm and extending beyond the midline while compressing the urinary bladder) were evaluated. Clinical outcomes, including 24-h transfusion requirements and mortality rates, were also evaluated. Our patients included 10 women and one man, with a mean age of 75.6 years. All patients sustained injuries involving the superior and inferior rami fractures. The internal pudendal (six patients), obturator (six patients), and aberrant obturator (five patients) arteries required AE. Five of these aberrant obturator arteries, which developed corona mortis, originated from the external iliac artery, and four out of five patients with aberrant obturator arteries had huge pelvic hematomas. We transfused 2.9 units of packed red blood cells on average, and one patient passed away 2 days after sustaining injuries. Attention should be directed towards cases with a huge hematoma on the CT scan or hemodynamic instability, even in the presence of a stable ramus fracture, in old patients. In such situations, evaluating the external iliac artery for angioembolization of the injured corona mortis is imperative.

Geriatric; Elderly; Pelvic fracture; Angioembolization; Corona mortis; Fragility pelvic fracture

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