Interdisciplinary Approach to Hemodynamically Unstable Patient With Pelvic Fracture: Successful Embolization and Surgical Fixation

Introduction Pelvic fractures can be divided from completely simple, not even requiring therapeutic help, to complex ones, accompanied by hemodynamic instability. The average mortality rate of patients with pelvic fractures is up to 40%, especially if it is bleeding from the internal iliac arteries. Injuries accompanied by pelvic fractures require immediate assistance, often interdisciplinary team. This case report aims to highlight the importance of rapid diagnosis and an interdisciplinary approach in managing hemodynamically unstable patients with complex pelvic fractures. Case Presentation A 67-year-old male was referred to our hospital due to a work-related injury after falling from two meters. The patient was examined according to the polytrauma protocol. During the examination, hemodynamic instability and palpable consciousness were observed, indicating hemorrhagic shock. X-rays of the chest, spine and pelvis showed a fracture of the right L5 transverse process and right-sided pubic body fracture extending into the superior and inferior rami, a comminuted fracture of the sacral lateral masses. A CT of the brain revealed bilateral small subarachnoid hemorrhages. The patient was discussed with an interventional radiologist and pelvic CT angiography was performed due to suspected internal bleeding and hemodynamic instability - active extravasation from the right internal iliac artery was identified and its embolization was performed. The patient was transferred to the intensive care unit for hemodynamic stabilization and after that open reduction and internal fixation of the pelvic fracture were performed using cannulated screws. This method is minimally invasive, allowing the patient to quickly regain function and reduce pelvic pain. Discussion This case report demonstrates the importance of interdisciplinary team and rapid diagnosis in patients with complex pelvic fractures and hemodynamic instability. Appropriate surgical management can significantly improve patient outcomes and reduce the risk of complications [5,6]. Conclusions Hemodynamically unstable patients with pelvic fractures require urgent and coordinated care. This case illustrates a successful combined strategy in radiology and orthopedic surgery treatment, emphasizing the effectiveness of interdisciplinary collaboration in managing complex pelvic fractures.