Surgical Relevance of Corona Mortis and Clinical Outcome in Pelvic Trauma

Introduction: The Corona Mortis (CM), also termed the crown of death, is an anastomosis between the obturator and the external iliac or inferior epigastric vessels. It has been accused to be a source of major bleeding complications in many instances. Not only pelvic surgeons know that dislocated fractures or iatrogenic injury may cause life-threatening bleeding. For the investigation of the incidence and surgical relevance of the CM, we conducted a retrospective study considering the intra- and peri-operative findings at our institution. Methods: All consecutive patients, who underwent pelvic surgery due to an acetabular fracture or pelvic ring instability were analysed. Patients were excluded if an approach without standard visualization of the CM was used. The incidence of the CM and its associated bleeding complications and mortality was investigated as documented by the operative report and patients’ medical records. After performing a two-tailed Kolmogorov-Smirnov test for normal distribution, a Mann-Whitney U test was used due to a nonparametric distribution to test nominal variables. P-values of <0.05 were considered statistically significant. Results: We evaluated the data of 130 consecutive patients. The incidence of the CM was 41.5% (n=54). Neither a significant correlation between the presence of the CM and bleeding complications (p=0.068), nor the mortality (p=0.068) was observed. The mortality was also not significantly affected by the presence of the CM or bleeding complications (p=0.338 and p=0.113, respectively). Conclusion: This study points out the high incidence of the CM. However, it is not associated with bleeding complications or mortality. Therefore, it does not seem to be the main source of bleeding in pelvic trauma in case of delayed surgery and can be regarded as a controllable anatomic structure.