Superior gluteal artery injury in pelvic ring injury and acetabular fracture: Single center observational study

• Published in: Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 2024-11, Vol.29 (6), p.1483-1488
• Main Authors: Kwon, Hoon, Jang, Jae Hoon, Moon, Nam Hoon, Rhee, Seung Joon, Ryu, Dong Yeon, Ahn, Tae Young
• Format: Article
• Language: English
• Subjects: Acetabular fracture; Acetabulum - diagnostic imaging; Acetabulum - injuries; Adult; Aged; Aged, 80 and over; Angiography; Arteries - injuries; Buttocks - blood supply; Buttocks - injuries; Embolization, Therapeutic; Female; Fractures, Bone - complications; Fractures, Bone - diagnostic imaging; Fractures, Bone - therapy; Humans; Male; Middle Aged; Pelvic Bones - diagnostic imaging; Pelvic Bones - injuries; Pelvic ring injury; Retrospective Studies; Superior gluteal artery injury; Vascular System Injuries - complications; Vascular System Injuries - diagnostic imaging; Vascular System Injuries - etiology; Vascular System Injuries - therapy; Young Adult
• ISSN: 0949-2658; 1436-2023; 1436-2023
• DOI: 10.1016/j.jos.2023.10.007

Intrapelvic hemorrhage following pelvic fractures, including pelvic ring and acetabular fractures, originates from the venous system and the fracture. Arterial injury often causes significant bleeding and hemodynamic instability. The superior gluteal artery (SGA) is a frequently injured artery in patients with pelvic fractures. This study investigated the incidence and pattern of SGA injuries associated with pelvic fractures. We retrospectively reviewed the medical records of patients with pelvic fractures who visited our institution between January 2016 and April 2022. Patients who underwent angiography for suspected arterial injury and SGA embolization were identified. Furthermore, the demographics and patterns of pelvic fractures were evaluated. In total, 2042 patients with pelvic fractures visited our trauma emergency department and 498 patients (24.4%) underwent embolization for arterial injuries. Of these, 30 patients (1.5% of the total and 6.0% of the patients who underwent procedures) received embolization therapy of the main trunk of the SGA. The mean age of patients was 51.2 (23–85 years), and the injury mechanisms were all high-energy injuries. There were 19 pelvic ring injuries, eight acetabular fractures, and three combined injuries. Acetabular fractures involved mostly both columns. The three combined injuries were lateral compression involving both columns, vertical shear involving both columns, and lateral compression with T-type fractures. Twelve (40.0%) occurred through the sciatic notch of different patterns. SGA injury occurred in 1.5% of all pelvic fractures and was identified in 6% of patients receiving embolization. SGA injury occurs through various injury mechanisms and fracture patterns, even in the absence of a fracture in the sciatic notch. However, no conclusions could be drawn in this study on the association between SGA injuries, injury mechanisms, and fracture patterns. Since the prediction of SGA injury by fracture pattern is limited, angiography should be performed regardless of fracture pattern when an injury is suspected.