Management of scrotal swelling after pelvic and acetabular fractures

Complex pelvic and acetabular fractures are usually associated with high-energy trauma and often present with substantial perineal soft tissue swelling. This is the result of the significant haemorrhage that develops into the retroperitoneal space, which dissects along fascial planes to extend into the scrotum. Other factors that could contribute to the progression of the soft tissue swelling include the extensive approaches used for surgical stabilization of the fractures, the prolonged traction using a perineal post and the early typical catabolic responses after major trauma. This article describes a successful protocol for the management of scrotal swelling associated with complex pelvic and acetabular fractures. Rapid reduction of the swelling in the scrotal region prevents the onset of perineal wound slough. It also minimizes the risk of infection in case of skin breakdown by isolation from the perianal region. Furthermore, it precludes friction of the scrotum with the skin of the thigh, thus allowing adequate pain relief and faster rehabilitation.