{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:50:34Z","timestamp":1792086634707,"version":"4.4.0"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Trauma Emerg Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Traumatic pelvic hemorrhage is a major driver of morbidity and mortality in pelvic fractures. Classic literature described pelvic hemorrhage as predominantly venous, whereas arterial injury is considered less common. We evaluated the frequency, anatomical distribution, and presumed sources of pelvic hemorrhage in a contemporary trauma cohort using contrast-enhanced CT (CECT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a single-center, retrospective cohort study of consecutive patients with pelvic fractures treated at a level-I trauma center between 2020 and 2022. All patients underwent CECT at initial presentation. Two experienced pelvic trauma surgeons independently reviewed all scans. Radiologically relevant hemorrhage was defined by contrast extravasation, soft-tissue asymmetry\/displacement, or a contained intrapelvic hematoma. Patients with and without hemorrhage were compared regarding age, sex, trauma mechanism, anticoagulation, and fracture type. The presumed bleeding sources were categorized as arterial, venous, cancellous, or mixed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Radiologically relevant hemorrhage occurred in 95\/512 (18.6%) patients and was more frequent after high-energy trauma and in men. Iliac sites predominated, whereas presacral bleeding was uncommon. The presumed bleeding source was cancellous in 44.2%, mixed in 29.5%, arterial in 18.9%, and isolated venous in 7.4%. Overall mortality was 7.0% and was significantly higher in patients with hemorrhage (14.7% vs. 5.3%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this contemporary CECT-based cohort, pelvic hemorrhage was less frequent than historically reported, with CT findings most commonly suggesting cancellous or mixed bleeding sources. These findings suggest that the traditional concept of predominantly venous pelvic hemorrhage may not fully reflect current CT-based observations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00068-026-03363-6","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:33:10Z","timestamp":1792085590000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pelvic hemorrhage in the context of demographic change: frequency and CT-based characterization of pelvic bleeding"],"prefix":"10.1007","volume":"52","author":[{"given":"Florentine","family":"Gerhardt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"H\u00f6ch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dmitry","family":"Notov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanette","family":"Henkelmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"Zeidler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Einhorn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Kleber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"issue":"8","key":"3363_CR1","doi-asserted-by":"publisher","first-page":"2090","DOI":"10.1007\/s11999-012-2276-9","volume":"470","author":"JH Holstein","year":"2012","unstructured":"Holstein JH, Culemann U, Pohlemann T, et al. What are predictors of mortality in patients with pelvic fractures? Clin Orthop Relat Res. 2012;470(8):2090\u20137. https:\/\/doi.org\/10.1007\/s11999-012-2276-9.","journal-title":"Clin Orthop Relat Res"},{"issue":"11","key":"3363_CR2","doi-asserted-by":"publisher","first-page":"957","DOI":"10.1007\/s00113-014-2565-8","volume":"118","author":"M Burkhardt","year":"2015","unstructured":"Burkhardt M, Nienaber U, Krause J, et al. Das komplexe Beckentrauma: Matching des Beckenregisters DGU mit dem TraumaRegister DGU\u00ae. Unfallchirurg. 2015;118(11):957\u201362. https:\/\/doi.org\/10.1007\/s00113-014-2565-8.","journal-title":"Unfallchirurg"},{"key":"3363_CR3","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/s13017-017-0117-6","volume":"12","author":"F Coccolini","year":"2017","unstructured":"Coccolini F, Stahel PF, Montori G, et al. Pelvic trauma: WSES classification and guidelines. World J Emerg Surg. 2017;12:5. https:\/\/doi.org\/10.1186\/s13017-017-0117-6.","journal-title":"World J Emerg Surg"},{"issue":"3","key":"3363_CR4","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1007\/s00414-016-1503-4","volume":"131","author":"M Hussami","year":"2017","unstructured":"Hussami M, Grabherr S, Meuli RA, Schmidt S. Severe pelvic injury: vascular lesions detected by ante- and post-mortem contrast medium-enhanced CT and associations with pelvic fractures. Int J Legal Med. 2017;131(3):731\u20138. https:\/\/doi.org\/10.1007\/s00414-016-1503-4.","journal-title":"Int J Legal Med"},{"issue":"10","key":"3363_CR5","doi-asserted-by":"publisher","first-page":"4525","DOI":"10.1007\/s00402-024-05447-7","volume":"144","author":"JE Madsen","year":"2024","unstructured":"Madsen JE, Flugsrud GB, Hammer N, Puchwein P. Emergency treatment of pelvic ring injuries: state of the art. Arch Orthop Trauma Surg. 2024;144(10):4525\u201339. https:\/\/doi.org\/10.1007\/s00402-024-05447-7.","journal-title":"Arch Orthop Trauma Surg"},{"issue":"2","key":"3363_CR6","doi-asserted-by":"publisher","first-page":"384","DOI":"10.3390\/diagnostics12020384","volume":"12","author":"E Leone","year":"2022","unstructured":"Leone E, Garipoli A, Ripani U, Lanzetti RM, Spoliti M, Creta D, Giannace C, Galluzzo A, Trinci M, Galluzzo M. Imaging review of pelvic ring fractures and its complications in high-energy trauma. Diagnostics. 2022;12(2):384. https:\/\/doi.org\/10.3390\/diagnostics12020384.","journal-title":"Diagnostics"},{"issue":"4","key":"3363_CR7","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1016\/j.injury.2007.01.007","volume":"38","author":"T Pohlemann","year":"2007","unstructured":"Pohlemann T, Tosounidis G, Bircher M, et al. The German Multicentre Pelvis Registry: a template for an European Expert Network. Injury. 2007;38(4):411\u201321. https:\/\/doi.org\/10.1016\/j.injury.2007.01.007.","journal-title":"Injury"},{"issue":"9","key":"3363_CR8","doi-asserted-by":"publisher","first-page":"e0139078","DOI":"10.1371\/journal.pone.0139078","volume":"10","author":"S Andrich","year":"2015","unstructured":"Andrich S, Haastert B, Neuhaus E, Neidert K, Arend W, Ohmann C, Grebe J, Vogt A, Jungbluth P, R\u00f6sler G, Windolf J, Icks A. Epidemiology of pelvic fractures in Germany: considerably high incidence rates among older people. PLoS ONE. 2015;10(9):e0139078. https:\/\/doi.org\/10.1371\/journal.pone.0139078.","journal-title":"PLoS ONE"},{"issue":"9","key":"3363_CR9","doi-asserted-by":"publisher","first-page":"e36","DOI":"10.2106\/JBJS.15.00793","volume":"98","author":"CM Court-Brown","year":"2016","unstructured":"Court-Brown CM, McQueen MM. Global forum: fractures in the elderly. J Bone Joint Surg Am. 2016;98(9):e36. https:\/\/doi.org\/10.2106\/JBJS.15.00793.","journal-title":"J Bone Joint Surg Am"},{"issue":"12","key":"3363_CR10","doi-asserted-by":"publisher","first-page":"1733","DOI":"10.1016\/j.injury.2013.06.023","volume":"44","author":"PM Rommens","year":"2013","unstructured":"Rommens PM, Hofmann A. Comprehensive classification of fragility fractures of the pelvic ring: recommendations for surgical treatment. Injury. 2013;44(12):1733\u201344. https:\/\/doi.org\/10.1016\/j.injury.2013.06.023.","journal-title":"Injury"},{"issue":"1","key":"3363_CR11","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1007\/s10140-018-1646-3","volume":"26","author":"W Borror","year":"2019","unstructured":"Borror W, Gaski GE, Steenburg S. Abdominopelvic bleed rate on admission CT correlates with mortality and transfusion needs in the setting of blunt pelvic fractures: a single institution pilot study. Emerg Radiol. 2019;26(1):37\u201344. https:\/\/doi.org\/10.1007\/s10140-018-1646-3.","journal-title":"Emerg Radiol"},{"issue":"6","key":"3363_CR12","doi-asserted-by":"publisher","first-page":"1850","DOI":"10.1097\/TA.0b013e31823dca9a","volume":"71","author":"DC Cullinane","year":"2011","unstructured":"Cullinane DC, Schiller HJ, Zielinski MD, Bilaniuk JW, Collier BR, Como J, Holevar M, Sabater EA, Sems SA, Vassy WM, Wynne JL. Eastern Association for the Surgery of Trauma practice management guidelines for hemorrhage in pelvic fracture: update and systematic review. J Trauma. 2011;71(6):1850\u201368. https:\/\/doi.org\/10.1097\/TA.0b013e31823dca9a.","journal-title":"J Trauma"},{"issue":"1","key":"3363_CR13","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1097\/TA.0000000000001259","volume":"82","author":"RB Tesoriero","year":"2017","unstructured":"Tesoriero RB, Bruns BR, Narayan M, Dubose J, Guliani SS, Brenner ML, Boswell S, Stein DM, Scalea TM. Angiographic embolization for hemorrhage following pelvic fracture: is it time for a paradigm shift? J Trauma Acute Care Surg. 2017;82(1):18\u201326. https:\/\/doi.org\/10.1097\/TA.0000000000001259.","journal-title":"J Trauma Acute Care Surg"},{"issue":"10","key":"3363_CR14","doi-asserted-by":"publisher","first-page":"111773","DOI":"10.1016\/j.injury.2024.111773","volume":"55","author":"M Jammal","year":"2024","unstructured":"Jammal M, Nasrallah K, Kanaann M, Mosheiff R, Liebergall M, Weil Y. Pelvic ring fracture in the older adults after minor pelvic trauma \u2013 is it an innocent injury? Injury. 2024;55(10):111773. https:\/\/doi.org\/10.1016\/j.injury.2024.111773.","journal-title":"Injury"},{"key":"3363_CR15","doi-asserted-by":"publisher","first-page":"588845","DOI":"10.3389\/fsurg.2020.588845","volume":"7","author":"M Marmor","year":"2020","unstructured":"Marmor M, El Naga AN, Barker J, Matz J, Stergiadou S, Miclau T. Management of pelvic ring injury patients with hemodynamic instability. Front Surg. 2020;7:588845. https:\/\/doi.org\/10.3389\/fsurg.2020.588845.","journal-title":"Front Surg"},{"issue":"7","key":"3363_CR16","doi-asserted-by":"publisher","first-page":"2111","DOI":"10.1148\/rg.2019190062","volume":"39","author":"SB Raniga","year":"2019","unstructured":"Raniga SB, Mittal AK, Bernstein M, Skalski MR, Al-Hadidi AM. Multidetector CT in vascular injuries resulting from pelvic fractures: a primer for diagnostic radiologists. Radiographics. 2019;39(7):2111\u201329. https:\/\/doi.org\/10.1148\/rg.2019190062.","journal-title":"Radiographics"},{"issue":"3","key":"3363_CR17","doi-asserted-by":"publisher","first-page":"193","DOI":"10.55095\/achot2012\/029","volume":"79","author":"A G\u00e4nsslen","year":"2012","unstructured":"G\u00e4nsslen A, Hildebrand F, Pohlemann T. Management of hemodynamic unstable patients in extremis with pelvic ring fractures. Acta Chir Orthop Traumatol Cech. 2012;79(3):193\u2013202. https:\/\/doi.org\/10.55095\/achot2012\/029.","journal-title":"Acta Chir Orthop Traumatol Cech"},{"issue":"5","key":"3363_CR18","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1097\/TA.0000000000001034","volume":"80","author":"TW Costantini","year":"2016","unstructured":"Costantini TW, Coimbra R, Holcomb JB, et al. Current management of hemorrhage from severe pelvic fractures: results of an American Association for the Surgery of Trauma multi-institutional trial. J Trauma Acute Care Surg. 2016;80(5):717\u201323. https:\/\/doi.org\/10.1097\/TA.0000000000001034.","journal-title":"J Trauma Acute Care Surg"},{"issue":"4","key":"3363_CR19","doi-asserted-by":"publisher","first-page":"628","DOI":"10.1016\/j.jamcollsurg.2010.12.020","volume":"212","author":"CC Burlew","year":"2011","unstructured":"Burlew CC, Moore EE, Smith WR, et al. Preperitoneal pelvic packing\/external fixation with secondary angioembolization: optimal care for life-threatening hemorrhage from unstable pelvic fractures. J Am Coll Surg. 2011;212(4):628\u201335. https:\/\/doi.org\/10.1016\/j.jamcollsurg.2010.12.020.","journal-title":"J Am Coll Surg"},{"issue":"4","key":"3363_CR20","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1016\/j.injury.2008.12.006","volume":"40","author":"T Suzuki","year":"2009","unstructured":"Suzuki T, Smith WR, Moore EE. Pelvic packing or angiography: competitive or complementary? Injury. 2009;40(4):343\u201353. https:\/\/doi.org\/10.1016\/j.injury.2008.12.006.","journal-title":"Injury"},{"issue":"5","key":"3363_CR21","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1001\/archsurg.138.5.504","volume":"138","author":"CC Blackmore","year":"2003","unstructured":"Blackmore CC, Jurkovich GJ, Linnau KF, Cummings P, Hoffer EK, Rivara FP. Assessment of volume of hemorrhage and outcome from pelvic fracture. Arch Surg. 2003;138(5):504\u20139. https:\/\/doi.org\/10.1001\/archsurg.138.5.504.","journal-title":"Arch Surg"},{"issue":"5","key":"3363_CR22","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1016\/j.ejrad.2011.02.049","volume":"81","author":"C Papakostidis","year":"2012","unstructured":"Papakostidis C, Kanakaris NK, Dimitriou R, Giannoudis PV. The role of arterial embolization in controlling pelvic fracture haemorrhage: a systematic review of the literature. Eur J Radiol. 2012;81(5):897\u2013904. https:\/\/doi.org\/10.1016\/j.ejrad.2011.02.049.","journal-title":"Eur J Radiol"},{"issue":"9","key":"3363_CR23","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1097\/BOT.0000000000000056","volume":"28","author":"L Toth","year":"2014","unstructured":"Toth L, King KL, McGrath B, Balogh ZJ. Factors associated with pelvic fracture-related arterial bleeding during trauma resuscitation: a prospective clinical study. J Orthop Trauma. 2014;28(9):489\u201395. https:\/\/doi.org\/10.1097\/BOT.0000000000000056.","journal-title":"J Orthop Trauma"},{"issue":"8","key":"3363_CR24","doi-asserted-by":"publisher","first-page":"1874","DOI":"10.1007\/s00268-008-9591-z","volume":"32","author":"DO Verbeek","year":"2008","unstructured":"Verbeek DO, Sugrue M, Balogh Z, et al. Acute management of hemodynamically unstable pelvic trauma patients: time for a change? Multicenter review of recent practice. World J Surg. 2008;32(8):1874\u201382. https:\/\/doi.org\/10.1007\/s00268-008-9591-z.","journal-title":"World J Surg"},{"issue":"4","key":"3363_CR25","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1007\/s00113-010-1762-3","volume":"113","author":"U Culemann","year":"2010","unstructured":"Culemann U, Scola A, Tosounidis G, Pohlemann T, Gebhard F. Concept for treatment of pelvic ring injuries in elderly patients. A challenge. Unfallchirurg. 2010;113(4):258\u201371. https:\/\/doi.org\/10.1007\/s00113-010-1762-3.","journal-title":"Unfallchirurg"},{"issue":"1","key":"3363_CR26","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1177\/2151458516682629","volume":"8","author":"A H\u00f6ch","year":"2017","unstructured":"H\u00f6ch A, \u00d6zkurtul O, Pieroh P, Josten C, B\u00f6hme J. Outcome and 2-year survival rate in elderly patients with lateral compression fractures of the pelvis. Geriatr Orthop Surg Rehabil. 2017;8(1):3\u20139. https:\/\/doi.org\/10.1177\/2151458516682629.","journal-title":"Geriatr Orthop Surg Rehabil"},{"issue":"2","key":"3363_CR27","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1302\/0301-620X.92B2.22488","volume":"92","author":"TA Ferguson","year":"2010","unstructured":"Ferguson TA, Patel R, Bhandari M, Matta JM. Fractures of the acetabulum in patients aged 60 years and older: an epidemiological and radiological study. J Bone Joint Surg Br. 2010;92(2):250\u20137. https:\/\/doi.org\/10.1302\/0301-620X.92B2.22488.","journal-title":"J Bone Joint Surg Br"},{"key":"3363_CR28","doi-asserted-by":"publisher","first-page":"38257","DOI":"10.1038\/s41598-025-22076-1","volume":"15","author":"S Matsumoto","year":"2025","unstructured":"Matsumoto S, Aoki M, Shimizu M. Prevalence and risk factors for major arterial bleeding in fragility pelvic fractures in the aging population. Sci Rep. 2025;15:38257. https:\/\/doi.org\/10.1038\/s41598-025-22076-1.","journal-title":"Sci Rep"},{"issue":"12","key":"3363_CR29","doi-asserted-by":"publisher","first-page":"1685","DOI":"10.1007\/s00402-009-0942-5","volume":"129","author":"D Krappinger","year":"2009","unstructured":"Krappinger D, Struve P, Schmid R, Kroesslhuber J, Blauth M. Fractures of the pubic rami: a retrospective review of 534 cases. Arch Orthop Trauma Surg. 2009;129(12):1685\u201390. https:\/\/doi.org\/10.1007\/s00402-009-0942-5.","journal-title":"Arch Orthop Trauma Surg"}],"container-title":["European Journal of Trauma and Emergency Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-026-03363-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00068-026-03363-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-026-03363-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:33:14Z","timestamp":1792085594000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00068-026-03363-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,15]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3363"],"URL":"https:\/\/doi.org\/10.1007\/s00068-026-03363-6","relation":{},"ISSN":["1863-9941"],"issn-type":[{"value":"1863-9941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,15]]},"assertion":[{"value":"9 August 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 October 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was performed in line with the principles of the Declaration of Helsinki. The study was approved by the Ethics Committee of the Medical Faculty of Leipzig University (reference no. 043\/23-ek).","order":1,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The requirement for informed consent was waived due to the retrospective study design.","order":2,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":3,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"320"}}