Corona Mortis Artery Avulsion Due to a Stable Pubic Ramus Fracture

A 70-year-old woman with osteoporosis fell at home and presented to our emergency department with intense left hip pain. Radiographs revealed a left iliopubic rami fracture and nondisplaced right ischiopubic rami fracture. She was discharged after a 24-hour observation with no clinical changes. Seventy-two hours later, she was readmitted with a painful abdominal mass, progressive oliguria, tachycardia, hypotension, and profuse perspiration with generalized pallor. On physical examination, a painful mass in the hypogastrium and intense inflammation in the thigh and the proximal portion of left knee were found. Emergent multiphase contrast computed tomography revealed a large nonhomogeneous hematoma neighboring the fractured left iliopubic rami, and contrast extravasation indicated arterial bleeding. Selective angiography showed an active hemorrhage from the distal portion of a small branch of the left obturator artery. After embolization of the arterial vessel, the patient was hemodynamically stable. The fracture was rotationally and vertically stable. These fractures are common, especially among the elderly. This type of injury is usually treated conservatively and with active mobilization once the acute pain has subsided. Supraselective embolization after localization of the bleeding vessels by arteriography is recognized as a minimally invasive procedure with excellent outcomes in hemorrhagic complications of pelvic fractures. An apparently benign pubic rami fracture in the setting of hemodynamic instability should raise the suspicion of a corona mortis injury, especially in elderly and anticoagulated patients.