Sakellariou E, Argyropoulou E, Galanis A, Rozis M, Zachariou D, Varsamos I, Parchas N, Kalavrytinos D, Karampinas P, Vasiliadis ES, Vlamis J, Pneumaticos S. Life-threatening vascular injury in an elderly patient with isolated pubic ramus fracture: A case report. World J Clin Cases 2025; 13(21): 103786 [DOI: 10.12998/wjcc.v13.i21.103786]
Corresponding Author of This Article
Evangelia Argyropoulou, MD, Department of Orthopaedics and Traumatology, University General Hospital of Patras, Rion 1, Patra 26504, Greece. eva.argirop@gmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jul 26, 2025; 13(21): 103786 Published online Jul 26, 2025. doi: 10.12998/wjcc.v13.i21.103786
Life-threatening vascular injury in an elderly patient with isolated pubic ramus fracture: A case report
Evangelos Sakellariou, Evangelia Argyropoulou, Athanasios Galanis, Meletis Rozis, Dimitrios Zachariou, Iordanis Varsamos, Nicolaos Parchas, Dimitrios Kalavrytinos, Panagiotis Karampinas, Elias S Vasiliadis, John Vlamis, Spiros Pneumaticos
Evangelos Sakellariou, Athanasios Galanis, Meletis Rozis, Dimitrios Zachariou, Iordanis Varsamos, Panagiotis Karampinas, Elias S Vasiliadis, John Vlamis, Spiros Pneumaticos, 3rd Department of Orthopaedic Surgery, KAT General Hospital, National & Kapodistrian University of Athens, Athens 14561, Greece
Evangelia Argyropoulou, Nicolaos Parchas, Department of Orthopaedics and Traumatology, University General Hospital of Patras, Patras 26504, Greece
Dimitrios Kalavrytinos, Department of Orthopaedic Surgery, 251 Air Force General Hospital, Athens 11525, Greece
Co-first authors: Evangelos Sakellariou and Evangelia Argyropoulou.
Author contributions: Sakellariou E, Argyropoulou E and Karampinas P designed research; Sakellariou E and Argyropoulou E performed research; Vlamis J, Varsamos I, Kalavrytinos D and Rozis M contributed analytic tools; Karampinas P, Parchas N, Vasiliadis ES and Pneumaticos S analyzed data; Sakellariou E, Argyropoulou E and Galanis A wrote the paper and; Zachariou D, Karampinas P acquisition funding. All authors have read and agreed to the published version of the manuscript. Sakellariou E and Argyropoulou E contributed equally to this work as co-first authors.
Informed consent statement: All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from the patient for being included in the study. The patient has signed a written consent form.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Evangelia Argyropoulou, MD, Department of Orthopaedics and Traumatology, University General Hospital of Patras, Rion 1, Patra 26504, Greece. eva.argirop@gmail.com
Received: December 3, 2024 Revised: February 20, 2025 Accepted: March 24, 2025 Published online: July 26, 2025 Processing time: 148 Days and 16.3 Hours
Abstract
BACKGROUND
Pubic ramus fractures are generally considered fragility fractures in the elderly population, commonly deriving from a low-impact fall. Treatment is ordinarily conservative and hemodynamic complications are exceedingly infrequent. Notwithstanding, patients with copious comorbidities should be carefully monitored for potential vascular injury.
CASE SUMMARY
This case report presents the management of a 75-year-old male patient with a history of diabetes mellitus and arterial hypertension who was admitted to the emergency room with a superior pubic ramus fracture. The patient experienced a significant drop in hematocrit and hemoglobin levels post-admission, necessitating urgent intervention. A computed tomography angiography revealed active bleeding, leading to the embolization of the medial femoral branch. The patient was stabilized hemodynamically and was discharged after 15 days, with recommendations for home-based follow-up care.
CONCLUSION
This report denotes the various challenges and strategies in managing simple fractures that are treated conservatively, but need prompt monitoring for occult vascular injuries that can be fatal.
Core Tip: Elderly patients with copious comorbidities, like diabetes mellitus and arterial hypertension, can potentially pose unique challenges in trauma management. Fragility fractures of the anterior pelvic ring are regarded as minor injuries, featuring rare complications. Hemodynamic monitoring is essential in management of these injuries. Fracture-associated occult vascular injuries are tremendously rare and can be fatal. The felicitous management of this case underlines the significance of multidisciplinary approach in the treatment of aged individuals with intricate past medical history. Continuous monitoring, timely diagnostic interventions, and pertinent therapeutic strategies are requisite in ensuring positive outcomes.
