A 42-year-old man with a vertically unstable pelvic fracture and left sacroiliac joint disruption remains hypotensive despite binder application and transfusion. Contrast-enhanced CT shows active extravasation adjacent to the greater sciatic notch. The most appropriate definitive hemostatic intervention is:

• A Open exploration and direct ligation of the bleeding vessel through the buttock
• B Immediate anterior external fixation and reassessment
• C Angiography with selective embolization of the superior gluteal artery ✓
• D Preperitoneal pelvic packing alone without angiography

Explanation

Disruption of the posterior ring tears the superior gluteal artery, the largest branch of the internal iliac artery, as it exits the greater sciatic notch. A focal arterial blush on CT is best managed by angiographic embolization, which achieves hemostasis without opening the retroperitoneal hematoma. Open exploration is discouraged because the tamponade effect is lost, and packing addresses diffuse venous bleeding rather than a defined arterial injury.

Reference: Rockwood and Green's Fractures in Adults, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.