Delayed presentation of hypovolemic shock after a simple pubic ramus fracture

Although trauma-induced simple pubic ramus fracture is common in the emergency department (ED), it can result in life-threatening hemorrhagic shock. We describe a 58-year-old woman with closed minimally displaced simple pubic ramus fracture. Hemodynamic instability became apparent 2 hours later. She...

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Bibliographic Details
Published in:The American journal of emergency medicine 2012-11, Vol.30 (9), p.2090.e1-2090.e4
Main Authors: Kong, Wai-Ming, MD, Sun, Cheuk-Kwan, MD, PhD, Tsai, I-Ting, MD
Format: Article
Language:English
Subjects:
Abdomen
Analgesics
Angiography
Blood pressure
Emergency
Emergency medical care
Emergency Service, Hospital
Female
Fractures, Closed - complications
Fractures, Closed - diagnostic imaging
Hemorrhage
Humans
Literature reviews
Medical imaging
Middle Aged
Mortality
Pubic Bone - blood supply
Pubic Bone - diagnostic imaging
Pubic Bone - injuries
Shock - etiology
Time Factors
Tomography, X-Ray Computed
Trauma
Veins & arteries
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Summary:Although trauma-induced simple pubic ramus fracture is common in the emergency department (ED), it can result in life-threatening hemorrhagic shock. We describe a 58-year-old woman with closed minimally displaced simple pubic ramus fracture. Hemodynamic instability became apparent 2 hours later. She was successfully treated with transarterial embolization and discharged uneventfully 10 days later. Literature review showed involvement of the superior pubic ramus in all reported cases probably because of hemorrhage from “corona mortis” with delay in shock presentation mostly within 6 hours, suggesting at least an equivalent observation period for these patients, particularly those at high risk for hemorrhage.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2011.12.030