Division of the Pubis for Massive Hemorrhage from Fractures of the Pelvis

This paper describes a recent experience with a patient with massive internal hemorrhage from traumatic fractures of the pelvis. The total blood loss exceeded 10 liters. This report was prompted by the ease with which the bleeding was controlled after the pubic symphysis was divided in order to expose the pelvic fractures. Division of the pubic symphysis to control intrapelvic hemorrhage has not been described in the recent surgical literature.

Report of a Case  A 52-year-old white man was seen in The Johns Hopkins Hospital emergency department on April 9, 1958, one hour after an automobile accident. Significant physical findings were a blood pressure of 88/60 mm. Hg, moderate tenderness in the right lower quadrant, and marked tenderness bilaterally over the superior and inferior pubic rami. An ecchymotic area, 2 in in diameter, was visible in the perineum, lying midway between the scrotum and the rectum. X-rays showed bilateral fractures