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- Case Report Latent Superior Gluteal Artery Injury by Entrapment between the Fragments in Transverse Acetabular Fracture - A Case Report -
- Hyuk Jin Choi, Byung Chul Kim, Hoon Kwon, Jae Hoon Jang
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Journal of Musculoskeletal Trauma 2021;34(1):30-33.
DOI: https://doi.org/10.12671/jkfs.2021.34.1.30
Published online: January 31, 2021
1Departments of Neurosurgery, Bio-Medical Research Institute, Pusan National University Hospital, Busan, Korea 
2Departments of Radiology, Bio-Medical Research Institute, Pusan National University Hospital, Busan, Korea
3Departments of Orthopaedic Surgery, Bio-Medical Research Institute, Pusan National University Hospital, Busan, Korea
2Departments of Radiology, Bio-Medical Research Institute, Pusan National University Hospital, Busan, Korea
3Departments of Orthopaedic Surgery, Bio-Medical Research Institute, Pusan National University Hospital, Busan, Korea
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Abstract
The superior gluteal artery is branched from the internal iliac artery and is located outside the pelvis through a greater sciatic notch. This anatomical characteristic makes the artery vulnerable to injury when pelvic fracture involves the sciatic notch. In the case of a superior gluteal artery injury, hemodynamic instability can occur, and appropriate evaluation and management are mandatory in the acute phase. On the other hand, if the initial detection of the injury is neglected due to a masked pattern, it can cause massive bleeding during surgery, resulting in difficult hemostasis. This paper reports an experience of a latent superior gluteal artery injury by entrapment between the fragments of a transverse acetabular fracture.
J Korean Fract Soc. 2021 Jan;34(1):30-33. Korean.
Published online Jan 25, 2021.
https://doi.org/10.12671/jkfs.2021.34.1.30
Published online Jan 25, 2021.
https://doi.org/10.12671/jkfs.2021.34.1.30
Copyright © 2021 The Korean Fracture Society. All rights reserved.
Case Report
Latent Superior Gluteal Artery Injury by Entrapment between the Fragments in Transverse Acetabular Fracture: A Case Report
Abstract
The superior gluteal artery is branched from the internal iliac artery and is located outside the pelvis through a greater sciatic notch. This anatomical characteristic makes the artery vulnerable to injury when pelvic fracture involves the sciatic notch. In the case of a superior gluteal artery injury, hemodynamic instability can occur, and appropriate evaluation and management are mandatory in the acute phase. On the other hand, if the initial detection of the injury is neglected due to a masked pattern, it can cause massive bleeding during surgery, resulting in difficult hemostasis. This paper reports an experience of a latent superior gluteal artery injury by entrapment between the fragments of a transverse acetabular fracture.
Keywords
Pelvic fracture, Sciatic notch, Superior gluteal artery injury
Figures
Fig. 1
(A) Antero-posterior radiograph of the pelvis obtained in the emergency room showed a transverse acetabular fracture. (B) Iliac oblique radiograph shows the same findings, which involved the sciatic notch. (C) The distal fragment of the fracture appeared to be stuck in the proximal fragment at the sciatic notch in three-dimensional computed tomography (arrow).
Fig. 2
Serial cut of contrast-enhanced pelvic computed tomography (CE-CT). (A) Arterial phase of CE-CT shows the proximal portion (arrow) and distal portion (arrowhead) of the superior gluteal artery above the sciatic notch. (B) The proximal portion disappeared, and only the distal portion (arrow) was observed near the sciatic notch. (C) Only the distal portion (arrow) was observed at the fractured sciatic notch. On the other hand, contrast leakage or hematoma was not observed.
Fig. 3
(A) Digital subtraction angiography (DSA) demonstrates cutoff with a filling defect in the left superior gluteal artery. (B) Selective embolization of the left superior gluteal artery was performed with microcoils using a sandwich technique. The configuration of microcoils in the superior gluteal artery shows compression of the left superior gluteal artery by the fracture fragment. (C) Post-embolization DSA shows complete exclusion of the cutoff segment of the left superior gluteal artery.
Fig. 4
Postoperative anteroposterior and iliac oblique radiograph shows a reduced fracture, and coils for embolization across the sciatic notch. No bleeding occurred during the surgery.
Fig. 5
Antero-posterior and iliac oblique radiograph at 15 months after surgery. Union was achieved without complications, such as delayed bleeding.
Notes
Financial support:This work was supported by clinical research grant in 2019 from Pusan National University Hospital.
Conflict of interests:None.
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