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

doi:10.12671/jkfs.2021.34.1.30

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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; 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

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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.

Keywords: Pelvic fracture, Sciatic notch, Superior gluteal artery injury

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

Case Report

Latent Superior Gluteal Artery Injury by Entrapment between the Fragments in Transverse Acetabular Fracture: A Case Report

Hyuk Jin Choi

, M.D., Byung Chul Kim

, M.D., Hoon Kwon

, M.D.,^* and Jae Hoon Jang

, M.D.^†

Author information

Author notes

- Department of Neurosurgery, Bio-Medical Research Institute, Pusan National University Hospital, Busan, Korea.
- ^*Department of Radiology, Bio-Medical Research Institute, Pusan National University Hospital, Busan, Korea.
- ^†Department of Orthopaedic Surgery, Bio-Medical Research Institute, Pusan National University Hospital, Busan, Korea.
Correspondence to: Jae Hoon Jang, M.D. Department of Orthopaedic Surgery, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea. Tel: +82-51-240-7248, Fax: +82-51-247-8395, Email: realjang1979@gmail.com

Received October 30, 2020; Revised November 18, 2020; Accepted November 18, 2020.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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).

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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.

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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.

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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.

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Fig. 5
Antero-posterior and iliac oblique radiograph at 15 months after surgery. Union was achieved without complications, such as delayed bleeding.

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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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Superior gluteal artery injury in pelvic ring injury and acetabular fracture: Single center observational study
Hoon Kwon, Jae Hoon Jang, Nam Hoon Moon, Seung Joon Rhee, Dong Yeon Ryu, Tae Young Ahn
Journal of Orthopaedic Science.2024; 29(6): 1483. CrossRef

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Latent Superior Gluteal Artery Injury by Entrapment between the Fragments in Transverse Acetabular Fracture - A Case Report -

J Korean Fract Soc. 2021;34(1):30-33. Published online January 31, 2021

DOI: https://doi.org/10.12671/jkfs.2021.34.1.30

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