Pelvic Fractures with Hemorrhage

A recent paper from Denver1 examines the unsolved problem of pelvic fractures and their attendant vigorous hemorrhage. In the older literature ligation of the hypogastric arteries was advocated to control bleeding from pelvic viscera. The maneuver was borrowed from the gynecologists, perhaps in desperation, by trauma surgeons faced with uncontrollable hemorrhage from the area of fractured pelvic bones, pelvic-wall musculature and extensive pelvic venous plexuses. The reports of treatment by arterial ligation remain inconclusive about whether success or failure came because of or in spite of such ligations.In an editorial comment, Ravitch2 took issue with those who advocate the . . .