Page 9 - Journal of Special Operations Medicine - Fall 2014

Traumatic Pelvic Hematoma After a
Military Static-Line Parachute Jump: A Case Series

George A. Barbee, DScPA-EM, PA-C; Zachary Booms, DO

ABSTRACT
The authors report five cases of pelvic hematoma without Case Presentations
associated pelvic fracture after military static-line para-
chute operations, a significantly underreported injury. Case 1
The case reports and discussion include initial emergency A 36-year-old male Soldier brought in via a military
department presentation, stabilization requirements, field litter ambulance presented to the emergency de-
and imaging, disposition, and management recommen- partment (ED) with a chief complaint of pelvic pain and
dations. Data were collected retrospectively through re- the inability to ambulate several hours after a military
view of medical records from a single institution over static-line parachute jump. On arrival, the patient was
the course of a single calendar year, 2012–2013. Pelvic in severe discomfort and complained of pelvic pain and
hematoma should be strongly considered in the patient abdominal fullness. He appeared to be in overt shock
with lower abdominal, hip, or pelvic pain after blunt with no obvious source. It was also disclosed that the
injury from parachute landing fall even in the absence patient had been undertriaged after his landing; this
of associated fracture. The cases discussed display this caused a 2-hour delay of appropriate disposition from
underreported injury and highlight the frequent neces- the sending service to the ED. The patient had no al-
sity for admission to a high-acuity care center for close lergies, was not taking any medications, and had no
monitoring. significant past medical, surgical, or family history. His
immunizations were current. His social history was
Keywords: hematoma, retroperitoneal hemorrhage, trauma, negative for tobacco, alcohol, and illicit drug use. He
vertical shear injury, military static-line parachute jump had no prior hospitalizations. His review of systems was
positive only for pelvic and abdominal pain and the in-
ability to ambulate.
Introduction
His vital signs on presentation were temperature 98.7ºF,
The risks of military static-line parachute operations— pulse rate 56/min, blood pressure 70/40mmHg, respira-
notably, orthopedic injuries on landing—are inherent. tion rate 20/min, and oxygen saturation 100% breath-
Even with a normal landing and under the best condi- ing room air. His exam was remarkable for suprapubic
tions, an injury can occur. A pelvic hematoma without tenderness as well as pelvic pain, both of which were
other associated injury sustained after a parachute- concerning for pelvic fracture. A focused assessment
landing fall is a relatively underreported injury with po- with sonography for trauma (FAST) exam was per-
tentially devastating complications. In the present study, formed and showed a 500mL fluid collection in the
we review our experience with this injury type and dis- pelvis. On the discovery of the fluid collection, 2U of
cuss the existing literature to determine and recommend emergency release blood were ordered, 2000mL normal
the best initial management method. saline was administered, and 1g tranexamic acid was
given intravenously. The patient’s initial labs were unre-
markable but his repeat hematocrit drawn 12 hours later
Methods
showed a 6.5% drop. Computed tomography (CT) scan
We retrospectively identified all Soldiers with pelvic showed a pelvic hematoma in the right anterior lower
hematoma without associated pelvic fracture present- pelvis displacing the urinary bladder posteriorly and
ing to Womack Army Medical Center, Fort Bragg, NC, to the left with no evidence of a pelvic fracture (Figure
that was sustained during military static-line parachute 1). The patient was admitted to the intensive care unit
jumps with subsequent parachute-landing falls over the (ICU) with the surgery service and subsequently trans-
course of 12 months. We identified five cases. ferred to a civilian medical facility with the capability

1