Management of Obturator Vein Hemorrhage by Pubic Ramus Osteotomy During Acetabular Fixation - a Technical Trick.

Abstract

It is known that hemorrhage from pelvic ring and acetabular fractures can cause hemodynamic instability. Methods to improve visualization and thus management of bleeding vessels are not commonly described. This report highlights techniques to manage hemorrhage from a retracted obturator vein during the definitive fixation of a complex acetabular fracture. After uncomplicated modified Stoppa anterior intrapelvic approach, abrupt and profuse bleeding was encountered from the distal end of a lacerated obturator vein, which had retracted into the obturator foramen. With unsuccessful attempts to achieve hemostasis, a superior pubic osteotomy was performed which allowed excellent visualization of the bleeding vein and ligation. It must be emphasized that the surgeon attempted all these other measures before performing an osteotomy. This technical trick contributes to the overall knowledge as a means of achieving emergent hemostasis associated with distal obturator vessel hemorrhage, a well described risk in complex acetabular fractures.