Galassi L, Ravini ML, Bassani R, Mercandalli G, Santoro GD. In the shadow of stability lies ruin: Occult vascular injuries in geriatric pelvic trauma. World J Clin Cases 2025; 13(29): 108403 [DOI: 10.12998/wjcc.v13.i29.108403]
Corresponding Author of This Article
Luca Galassi, Lecturer, MD, Researcher, Postgraduate School of Vascular and Endovascular Surgery, University of Milan, Festa del Perdono Street, Milan 20122, Lombardy, Italy. luca.galassi@unimi.it
Research Domain of This Article
Surgery
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Luca Galassi, Postgraduate School of Vascular and Endovascular Surgery, University of Milan, Milan 20122, Lombardy, Italy
Matteo Lino Ravini, Giulio Mercandalli, Vascular and Endovascular Unit, IRCCS Galeazzi-Sant’Ambrogio, Milan 20157, Lombardy, Italy
Roberto Bassani, Spinal Surgery Unit, IRCCS Galeazzi-Sant'Ambrogio, Milan 20157, Lombardy, Italy
Giuseppe Diodato Santoro, Postgraduate School of Orthopaedics and Traumatology Surgery, University of Milan, Milan 20122, Lombardy, Italy
Author contributions: Galassi L, Ravini ML, Bassani R, Mercandalli G, Santoro GD contributed to this paper, designed the overall concept and outline, and wrote the manuscript; all of the authors read and approved the final version of the manuscript to be published.
Conflict-of-interest statement: Luca Galassi, Matteo Lino Ravini, Roberto Bassani, Giulio Mercandalli, Giuseppe Diodato Santoro have nothing to disclose.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Luca Galassi, Lecturer, MD, Researcher, Postgraduate School of Vascular and Endovascular Surgery, University of Milan, Festa del Perdono Street, Milan 20122, Lombardy, Italy. luca.galassi@unimi.it
Received: April 14, 2025 Revised: May 24, 2025 Accepted: July 22, 2025 Published online: October 16, 2025 Processing time: 137 Days and 12.3 Hours
Abstract
Frailty fractures of the pelvis, particularly isolated pubic ramus fractures, are often perceived as benign, especially in elderly patients. However, this perception can obscure the risk of delayed hemorrhage from occult vascular injuries. Clinical deterioration is frequently subtle, with signs like fatigue or confusion misattributed to baseline status. In frail patients, these injuries may rapidly evolve into life-threatening scenarios. Conservative management, while standard, may be insufficient when vascular frailty or anticoagulation are present. Early clinical suspicion, serial hemoglobin checks, and multidisciplinary involvement are crucial. A dynamic assessment model that incorporates frailty, comorbidities, and physiological reserve alongside radiographic findings can better guide intervention and monitoring. Clinicians must lower the threshold for advanced imaging, such as computed tomography angiography, and consider early vascular consultation even in seemingly stable cases. Adopting a holistic, risk-based approach can mitigate complications and improve outcomes for this vulnerable population
Core Tip: Isolated pubic ramus fractures, often labeled as stable on imaging, can pose serious risks in elderly patients. Frailty, anticoagulant therapy, and vascular fragility increase the likelihood of delayed hemorrhage from small arterial branches, even after low-energy trauma. Clinical decline is often subtle, with signs like confusion or fatigue mistaken for baseline status. Overreliance on fracture morphology can delay recognition of life-threatening bleeding. Incorporating frailty screening, serial hemoglobin checks, and early vascular consultation supports timely diagnosis and intervention. A dynamic, multidisciplinary approach is essential to reduce complications and ensure safer outcomes for this high-risk, frequently underestimated population.
