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Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Management of Pelvic Fractures With Urogenital Injuries
Colin K Cantrell1, Christopher D Flanagan, Hassan R Mir
1From the Department of Orthopaedic Surgery, University of Louisville, Louisville, KY (Cantrell), and the Department of Orthopaedic Surgery, Florida Orthopaedic Institute, University of South Florida, Tampa, FL (Flanagan and Mir).
Summary
Pelvic ring fractures often cause bladder and urethral injuries. Early diagnosis and coordinated orthopaedic-urologic care are crucial for managing these urogenital traumas and preventing long-term dysfunction.
Area of Science:
- Orthopaedic Surgery
- Urologic Surgery
- Trauma Management
Background:
- Pelvic ring injuries frequently coexist with bladder and urethral damage due to anatomical proximity.
- Urogenital injuries complicate 6-16% of pelvic fractures, significantly increasing morbidity and mortality.
- Diagnosis involves physical exam, urinalysis, and imaging like retrograde urethrogram and cystography.
Purpose of the Study:
- To review the diagnosis and management of urogenital injuries associated with pelvic ring fractures.
- To highlight the importance of multidisciplinary care for optimizing outcomes.
- To discuss current evidence regarding surgical fixation in the presence of bladder injury.
Main Methods:
- Review of literature on pelvic ring injuries and associated urogenital trauma.
- Analysis of diagnostic modalities and treatment strategies for bladder and urethral injuries.
- Evaluation of long-term consequences and management approaches.
Main Results:
- Lateral compression and AP compression pelvic fractures are linked to urogenital injuries.
- Pubic symphysis diastasis is a strong predictor of urogenital involvement.
- Management varies from conservative drainage to surgical repair for bladder injuries; urethral trauma often requires realignment or diversion.
Conclusions:
- Coordinated orthopaedic-urologic management is essential for optimal functional and quality-of-life outcomes.
- Modern evidence supports internal fixation for pelvic stabilization, even with bladder injury, without increased infection risk.
- Addressing long-term consequences like excretory and sexual dysfunction requires a multidisciplinary approach.
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