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Olszewski NP, Sliepka J, Bigham JJ, Firoozabadi R, Githens MJ, Routt MC, Kleweno CP. Factors Associated With Infection in Patients With Combined Pelvic Ring and Bladder Injuries. J Orthop Trauma 2024; 38:459-465. [PMID: 39150296 DOI: 10.1097/bot.0000000000002846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVES To identify the infection rate in patients with combined pelvic ring and bladder injuries. Secondary aims included identifying treatment and injury factors associated with infection. METHODS DESIGN Retrospective review. SETTING Single Level I Tertiary Academic Center. PATIENTS SELECTION CRITERIA All patients over a 12-year period with combined pelvic ring and bladder injuries were evaluated. Exclusion criteria were nonoperative management of the pelvic ring, isolated posterior fixation, and follow-up <90 days. OUTCOME MEASURE AND COMPARISONS Primary outcome measured was deep infection of the anterior pelvis requiring surgical irrigation and debridement. RESULTS In total, 106 patients with anterior stabilization of the pelvis in the setting of a bladder injury were included. Seven patients (6.6%) developed a deep infection and required surgical debridement within 90 days. Patients undergoing open reduction and internal fixation with plating of the anterior pelvis and acute concomitant bladder repair had an infection rate of 2.2% (1/43). Patients undergoing closed reduction and anterior fixation with either external fixation or percutaneous rami screw after bladder repair had an infection rate of 17.6% (3/17). There was a higher infection rate among patients with combined intraperitoneal (IP) and extraperitoneal (EP) bladder injuries (23%) when compared with those with isolated EP (3.8%) or IP (9.1%) bladder injuries (P = 0.029). CONCLUSIONS Acute open reduction and internal fixation of the anterior pelvis in patients with combined pelvic ring and bladder injuries has a low infection rate. Patients with combined IP and EP bladder injuries are at increased risk of infection compared with those with isolated IP and EP injuries. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Joseph Sliepka
- Department of Orthopaedics and Sports Medicine, University of Washington, Harborview Medical Center, Seattle, WA; and
| | - Joseph J Bigham
- Department of Orthopaedics and Sports Medicine, University of Washington, Harborview Medical Center, Seattle, WA; and
| | - Reza Firoozabadi
- Department of Orthopaedics and Sports Medicine, University of Washington, Harborview Medical Center, Seattle, WA; and
| | - Michael J Githens
- Department of Orthopaedics and Sports Medicine, University of Washington, Harborview Medical Center, Seattle, WA; and
| | - Milton Chip Routt
- Department of Orthopedic Surgery, UT Health Houston, McGovern Medical School, Houston, TX
| | - Conor P Kleweno
- Department of Orthopaedics and Sports Medicine, University of Washington, Harborview Medical Center, Seattle, WA; and
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Saiz AM, O'Donnell E, Kellam P, Cleary C, Moore X, Schultz BJ, Mayer R, Amin A, Gary J, Warner SJ, Routt ML, Eastman JG. Bladder Repair With Irrigation and Debridement and Open Reduction Internal Fixation of the Anterior Pelvic Ring Is Safe and Decreases Risk of Infection in Pelvic Ring Injuries With Extraperitoneal Bladder Ruptures. J Orthop Trauma 2024; 38:72-77. [PMID: 37941118 DOI: 10.1097/bot.0000000000002720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES To determine the incidence of infection in nonoperative versus operative management of extraperitoneal bladder ruptures in patients with pelvic ring injuries. METHODS DESIGN A retrospective cohort study of 2 prospectively collected trauma registries. SETTING Two Level 1 trauma centers. PATIENT SELECTION CRITERIA Patients with operative pelvic ring injuries, 68 (6%) had extraperitoneal bladder ruptures. OUTCOME MEASURES AND COMPARISONS The primary outcome was the incidence and associated risk factors of deep pelvic infection requiring return to OR for surgical debridement. Secondary outcomes included quality of reduction, other complications, and radiographic union. Comparisons were made based on the status of any associated bladder injury. RESULTS Of 1127 patients with operative pelvic ring injuries, 68 patients had extraperitoneal bladder ruptures, 55 had bladder repair and 13 did not. Of those 13 without repair, none had ORIF of the anterior pelvic ring. Patients without bladder repair had an increased odds of infection 17-fold compared to patients who did have a repair performed (OR 16.9, 95% CI 1.75 - 164, P = 0.01). Other associated factors for deep pelvic infection included use of suprapubic catheter ( p < 0.02) and a closed reduction of the anterior ring ( p < 0.01). Patients undergoing anterior ring ORIF and bladder repair had improved reductions and no increased infection risk. CONCLUSIONS Operative repair of extraperitoneal bladder ruptures decreases risk of infection in patients with pelvic ring injuries. Additionally, ORIF of the anterior pelvic ring does not increase the risk of infection and results in better reductions compared to closed reduction. Treatment algorithms for these combined injuries should consider recommending early bladder repair and anterior pelvic ORIF. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Augustine M Saiz
- University of Texas Health Science Center at Houston, Houston, TX
- University of California, Davis, Sacramento, CA; and
| | | | - Patrick Kellam
- University of Texas Health Science Center at Houston, Houston, TX
| | - Courtney Cleary
- University of Texas Health Science Center at Houston, Houston, TX
| | - Ximia Moore
- University of Texas Health Science Center at Houston, Houston, TX
| | - Blake J Schultz
- University of Texas Health Science Center at Houston, Houston, TX
| | - Ryan Mayer
- University of Texas Health Science Center at Houston, Houston, TX
| | - Adeet Amin
- University of Texas Health Science Center at Houston, Houston, TX
| | - Joshua Gary
- Keck School of Medicine of USC, Los Angeles, CA
| | - Stephen J Warner
- University of Texas Health Science Center at Houston, Houston, TX
| | - Milton L Routt
- University of Texas Health Science Center at Houston, Houston, TX
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Zhao X, Lu S, Wang B, Zhou X, Liu F, Xu W, Zhou D, Li L, Dong J. Fracture Types Influence the Likelihood of Lower Urinary Tract Injuries in Patients with Pelvic Fractures. J Clin Med 2023; 12:jcm12082967. [PMID: 37109301 PMCID: PMC10145837 DOI: 10.3390/jcm12082967] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The combination of pelvic fractures with lower urinary tract injuries (LUTIs) is a severe traumatic injury. This study was performed to determine the relationship between LUTIs and pelvic fracture types. METHODS Patients who sustained pelvic fractures combined with LUTIs between 1 January 2018 and 1 January 2022 in our institution were retrospectively analyzed. The patients' demographics, mechanism of injury, presence of open pelvic fractures, types of pelvic fractures, patterns of LUTIs, and early complications were analyzed. The association between pelvic fracture types and the identified LUTIs was statistically analyzed. RESULTS This study involved 54 patients diagnosed with pelvic fractures combined with LUTIs. The overall incidence of pelvic fractures combined with LUTIs was 7.7% (n = 54/698). All patients had unstable pelvic fractures. The male:female ratio was approximately 2.4:1.0. The incidence of LUTIs was higher in men than women with pelvic fractures (9.1% vs. 4.4%). Bladder injuries occurred at roughly equal rates in men and women (4.5% vs. 4.4%, p = 0.966), but urethral injuries were more frequent in men (6.1% vs. 0.5%, p = 0.001). The most common pelvic injury pattern was a type C fracture according to the Tile classification and a vertical-shear-type fracture according to the Young-Burgess classification. The Young-Burgess fracture classification was related to the severity of bladder injury in men (p = 0.037). There was no significant difference in bladder injury according to the two classifications among women (p = 0.524 vs. p = 1.000) or among the entire cohort (p = 0.454 vs. p = 0.342). CONCLUSIONS Men and women are equally likely to sustain a bladder injury, but a urethral injury with pelvic fracture is more frequent in men. LUTIs tend to be accompanied by unstable pelvic fractures. It is imperative to be vigilant for potential bladder injury when men sustain vertical-shear-type pelvic fractures.
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Affiliation(s)
- Xuehui Zhao
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Shun Lu
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Bingzhi Wang
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Xiaofeng Zhou
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Fanxiao Liu
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Weicheng Xu
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Dongsheng Zhou
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Lianxin Li
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Jinlei Dong
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
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Garay M, McKinney R, Wheatley B, Altman DT, Altman GT, Westrick ER. Complications of surgically treated pelvic ring injuries with associated genitourinary injuries. Injury 2023; 54:960-963. [PMID: 36725489 DOI: 10.1016/j.injury.2023.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/16/2023] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Pelvic ring injuries are often associated with vascular and intrapelvic organ injuries including damage to the genitourinary system. The purpose of this study was to examine the relationship between surgically treated pelvic ring injuries and genitourinary injuries. The primary outcome was to determine the rate of post-operative complications including infection, urinary dysfunction, and sexual dysfunction. The secondary outcome was to determine if the time to surgery was associated with post-operative complications. METHODS Retrospective chart review from September 1, 2015 to December 31, 2019 of patients who sustained a pelvic ring injury which required surgical intervention. All patients with closed triradiate cartilage were included. RESULTS A total of 115 patients met the inclusion criteria, 12 patients with an associated genitourinary (GU) injury were included in the GU group and 103 without GU injury were placed in the non-GU group. The median (range) age of patients in the GU group was 49.5 years (20, 64) and 48 years (15, 92) in the control group (p = 0.92). Demographic characteristics including age, Injury Severity Score and Elixhauser comorbidity score were similar between groups. Within the GU group, five patients had an injury to their bladder, four to their urethra and three had an injury to their kidney. In the GU group, one patient developed a wound dehiscence and one developed a urinary tract infection with subsequent sepsis (17%), while in the non-GU group, one patient (1%) developed erectile dysfunction (p = 0.028). Regression analysis demonstrated that having concomitant pelvic ring and GU injuries, as well as the number of surgeries were variables associated with post-operative complications, while time to surgery was not. DISCUSSION AND CONCLUSIONS Pelvic ring injuries with concomitant genitourinary injuries were associated with increased odds of post-operative complications. No differences were noted in complication rates due to the time to surgery between groups.
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Affiliation(s)
- Mariano Garay
- Allegheny General Hospital Department of Orthopaedic Surgery, Pittsburgh, PA 320 E North Ave, Pittsburgh, PA 15212, United States.
| | - Richard McKinney
- Allegheny General Hospital Department of Orthopaedic Surgery, Pittsburgh, PA 320 E North Ave, Pittsburgh, PA 15212, United States.
| | - Benjamin Wheatley
- Allegheny General Hospital Department of Orthopaedic Surgery, Pittsburgh, PA 320 E North Ave, Pittsburgh, PA 15212, United States
| | - Daniel T Altman
- Allegheny General Hospital Department of Orthopaedic Surgery, Pittsburgh, PA 320 E North Ave, Pittsburgh, PA 15212, United States.
| | - Gregory T Altman
- Allegheny General Hospital Department of Orthopaedic Surgery, Pittsburgh, PA 320 E North Ave, Pittsburgh, PA 15212, United States.
| | - Edward R Westrick
- Allegheny General Hospital Department of Orthopaedic Surgery, Pittsburgh, PA 320 E North Ave, Pittsburgh, PA 15212, United States.
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Lefaivre KA, Roffey DM, Guy P, O'Brien PJ, Broekhuyse HM. Quantifying Urinary and Sexual Dysfunction After Pelvic Fracture. J Orthop Trauma 2022; 36:118-123. [PMID: 34407035 DOI: 10.1097/bot.0000000000002247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To quantify the severity of urinary and sexual dysfunction and to evaluate the relationship between urinary and sexual dysfunction, injury, and treatment factors in patients with pelvic fracture. DESIGN Prospective cohort study. SETTING Level 1 trauma center. PATIENTS/PARTICIPANTS One hundred thirteen patients with surgically treated pelvic fracture (65.5% OTA/AO 61B fractures; 7 open fractures; 74 men). INTERVENTIONS Surgical pelvic stabilization. MAIN OUTCOME MEASURES The 36-Item Short Form Health Survey and International Consultation Incontinence Questionnaire responses were collected at baseline, 6 months, and 1, 2, and 5 years. Patients were scored on symptoms of voiding and incontinence, and filling (for women), to derive urinary function. Sexual function was scored as a single domain. Both genders reported urinary and sexual bothersome symptoms. Regression analysis was used to isolate the importance of predictive factors on urinary and sexual function, urinary and sexual bother, and their impact on quality of life. RESULTS Patients with pelvic fracture have significant urinary and sexual dysfunction, which is sustained or worsens over time. Male urinary function was predicted by Injury Severity Score (P = 0.03) and 61C fracture (odds ratio: 3.23, P = 0.04). Female urinary function was predicted by urinary tract injury at admission (odds ratio: 7.57, P = 0.03). Neurologic injury and anterior fixation were identified as significant predictors for male sexual function and sexual bother, whereas urological injuries were important in predicting female urinary and sexual bother (P < 0.01). Sexual function (P = 0.02) and sexual bother (P < 0.001) were important predictors of overall mental well-being in men. CONCLUSIONS Urinary and sexual dysfunction are prevalent and sustained in men and women and do not follow the prolonged slow recovery trajectory seen in physical function. Male urinary and sexual dysfunction was closely tied to neurologic injury, whereas female urinary and sexual dysfunction was predicted by the presence of a urinary tract injury. Urinary and sexual dysfunction were important to overall mental well-being in men. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kelly A Lefaivre
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada ; and
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Darren M Roffey
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Pierre Guy
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada ; and
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Peter J O'Brien
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada ; and
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Henry M Broekhuyse
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada ; and
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
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Kazley JM, Potenza MA, Marthy AG, Arain AR, O'Connor CM, Czajka CM. Team Approach: Evaluation and Management of Pelvic Ring Injuries. JBJS Rev 2021; 8:e0149. [PMID: 33006457 DOI: 10.2106/jbjs.rvw.19.00149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A multidisciplinary approach to the management of pelvic ring injuries has been shown to decrease mortality rates. The primary goals within the emergency room are to assess, resuscitate, and stabilize the patient. The Advanced Trauma Life Support protocol guides the initial assessment of the patient. A pelvic binder or sheet should be applied to help to provide reduction of the fracture and temporary stabilization. The trauma team becomes the primary service for the patient as he or she transitions away from the emergency department. The trauma team must effectively communicate with and serve as the liaison between other specialists as injuries are identified. emodynamic stability should be closely monitored in patients with pelvic ring injuries, involving the assessment of vital signs, imaging findings, and clinical judgment. Angioembolization and peritoneal packing may play a role in helping to control hemorrhage. Urologists should be consulted if a Foley catheter cannot be passed or there is concern for urethral or bladder injury. Further imaging or urologic intervention may be necessary. Orthopaedic surgeons can help to assess the patient, classify the injury, and assist in temporary stabilization while planning definitive fixation.
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Affiliation(s)
- Jillian M Kazley
- 1Divisions of Orthopaedic Surgery (J.M.K., A.R.A., C.M.O., and C.M.C.), Emergency Medicine (M.A.P.), and General Surgery (A.G.M.), Albany Medical Center, Albany, New York
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Chen YC, Chuang CH, Hsieh MH, Yeh HW, Yang SF, Lin CW, Yeh YT, Huang JY, Liao PL, Chan CH, Yeh CB. Risk of Mortality and Readmission among Patients with Pelvic Fracture and Urinary Tract Infection: A Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094868. [PMID: 34063602 PMCID: PMC8124968 DOI: 10.3390/ijerph18094868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 11/16/2022]
Abstract
Patients with pelvic fractures could encounter various complications during or after treatments. This cohort study investigated the risk of mortality and readmissions in patients with pelvic fractures, with or without urinary tract infections (UTIs), within 30 days following the pelvic fractures. This retrospective cohort study examined claim records from the Longitudinal Health Insurance Database 2000 (LHID2000). We selected patients hospitalized with pelvic fractures between 1997 and 2013 for study. Patients who had index data before 2000 or after 2010 (n = 963), who died before the index date (n = 64), who were aged <18 years (n = 94), or who had a pelvic injury (n = 31) were excluded. In total, the study cohort comprised 1623 adult patients; 115 had UTIs, and 1508 patients without UTIs were used as a comparison cohort. Multivariate analysis with a multiple Cox regression model and Kaplan-Meier survival analysis were performed to analyze the data. Our results showed that the 1-year mortality rate (adjusted hazard ratio [HR]: 2.32; 95% CI: 1.25-4.29) and readmission rate (adjusted HR: 1.72; 95% CI: 1.26-3.34) of the UTI group were significantly higher than those of the non-UTI group. Moreover, the Kaplan-Meier curve for the 1-year follow-up indicated that the UTI group had a higher cumulative risk of both mortality and hospital readmission compared with the non-UTI group. In conclusion, among patients with pelvic fracture, patients with UTI were associated with increased risks of mortality and readmission. Physicians must pay more attention to such patients to prevent UTIs among patients with pelvic fractures during hospitalization and conduct a follow-up after discharge within at least 1 year.
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Affiliation(s)
- Ying-Cheng Chen
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (Y.-C.C.); (C.-H.C.); (S.-F.Y.); (J.-Y.H.)
- Department of Surgery, Changhua Christian Hospital, Changhua 500, Taiwan
| | - Cheng-Hsun Chuang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (Y.-C.C.); (C.-H.C.); (S.-F.Y.); (J.-Y.H.)
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan;
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Ming-Hong Hsieh
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan;
- Department of Psychiatry, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Han-Wei Yeh
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (Y.-C.C.); (C.-H.C.); (S.-F.Y.); (J.-Y.H.)
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan;
| | - Chiao-Wen Lin
- Institute of Oral Sciences, Chung Shan Medical University, Taichung 402, Taiwan;
| | - Ying-Tung Yeh
- Graduate School of Dentistry, School of Dentistry, Chung Shan Medical University, Taichung 402, Taiwan;
- Department of Dentistry, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Jing-Yang Huang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (Y.-C.C.); (C.-H.C.); (S.-F.Y.); (J.-Y.H.)
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan;
| | - Pei-Lun Liao
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan;
| | - Chi-Ho Chan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan;
- Department of Microbiology and Immunology, Chung Shan Medical University, Taichung 402, Taiwan
- Correspondence: (C.-H.C.); (C.-B.Y.)
| | - Chao-Bin Yeh
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (Y.-C.C.); (C.-H.C.); (S.-F.Y.); (J.-Y.H.)
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan;
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Correspondence: (C.-H.C.); (C.-B.Y.)
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Treatment Discrepancy for Pelvic Fracture Patients With Urethral Injuries: A Survey of Orthopaedic and Urologic Surgeons. J Orthop Trauma 2019; 33:e280-e284. [PMID: 30939506 DOI: 10.1097/bot.0000000000001482] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES In patients with traumatic pelvic fracture urethral injuries (PFUI), the interaction between urethral management and orthopaedic decision making remains unknown. We aimed to survey orthopaedic and urologic surgeons to assess interdisciplinary interactions in the management of PFUI. METHODS An anonymous cross-sectional survey of members of the Orthopaedic Trauma Association (OTA) and the Society of Genitourinary Reconstructive Surgeons (GURS) was conducted between September 2017 and August 2018. Participants were queried regarding the impact of urethral injuries and their management on orthopaedic operative decision making. RESULTS Fifty-three GURS and 64 OTA members responded (17% response rate). For urethral injury management, 73% of OTA respondents preferred that suprapubic tubes (SPTs) were not placed for urethral injury management, whereas 43% of GURS respondents preferred SPTs (P = 0.08). Ninety-two percent of OTA respondents stated that SPTs increase hardware infection risks in patients undergoing pelvic open reduction with internal fixation (ORIF), whereas only 8% of GURS respondents agreed (P < 0.01). Although 66% of GURS respondents reported not considering the operative plans of orthopaedics when determining urethral management, 75% of OTA respondents reported that they were less inclined to proceed with ORIF, and 70% would perform external fixation in the setting of an SPT, despite 78% believing that this resulted in an inferior outcome for the patient. CONCLUSIONS There is discordance between urologists and orthopaedists as to the optimal management of PFUI patients, with significant disagreement regarding the infectious risks of SPT in the setting of ORIF. Improved data and interdisciplinary dialogue are required to maximize patient outcomes. LEVEL OF EVIDENCE Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.
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Risk of infectious complications in pelvic fracture urethral injury patients managed with internal fixation and suprapubic catheter placement. J Trauma Acute Care Surg 2019; 85:536-540. [PMID: 29985241 DOI: 10.1097/ta.0000000000002012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND There exists significant controversy regarding the use of suprapubic tubes (SPT) in pelvic fracture urethral injury (PFUI) patients undergoing internal fixation (IF) as to the potential risk of infection. Using the National Trauma Data Bank, we sought to examine if placement of SPT in patients with traumatic urethral injuries undergoing IF of pelvic fractures increases the risks of infectious complications during the index hospitalization. PATIENTS AND METHODS Using International Classification of Disease, version 9 and Abbreviated Injury Scale codes, patients with PFUI were identified in the National Trauma Data Bank between 2002 and 2014. International Classification of Disease, version 9 codes were used to identify patients who underwent IF of pelvic fractures, as well as those who underwent SPT placement. Covariates analyzed included age, Injury Severity Score (ISS), diabetes, hypertension, coronary artery disease, obesity, smoking status, associated colorectal injuries, and pelvic angioembolization. Demographics, management and infectious complications were compared between IF patients who did or did not undergo SPT placement using χ and t tests. Poisson regression analysis was performed to identify independent predictors of infectious complications. RESULTS Six hundred ninety-six PFUI patients were identified. Two hundred four (29.3%) patients underwent IF during the index hospitalization, of which 35 underwent concomitant SPT placement during that same admission. There was no difference in likelihood of undergoing IF in patients with or without SPT (p = 0.36). Multivariate analysis revealed that only ISS (Relative risk [RR], 4.00; 95% confidence interval, 1.25-12.77) and smoking status (RR, 2.45; 95% confidence interval, 1.11-5.43) were significant predictors of infectious complications, while SPT placement was not. CONCLUSION Among patients with PFUI undergoing IF, SPT placement does not appear to increase the risk for acute infectious complications during the index hospitalization, while higher ISS and smoking are significantly associated. Further longitudinal studies are required to provide definitive recommendations regarding the long-term safety of SPT placement in this patient population. LEVEL OF EVIDENCE Prognostic, level IV.
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Lamin E, Kovell RC, DeFroda SF. Simultaneous Treatment of Pelvic and Urological Injuries. JBJS Rev 2017; 5:e6. [DOI: 10.2106/jbjs.rvw.17.00057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Traumatic Testicular Dislocation Associated with Lateral Compression Pelvic Ring Injury and T-Shaped Acetabulum Fracture. Case Rep Orthop 2016; 2016:9706392. [PMID: 27672464 PMCID: PMC5031850 DOI: 10.1155/2016/9706392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 08/21/2016] [Indexed: 11/17/2022] Open
Abstract
We report a case of a unilateral testicular dislocation to the superficial inguinal region associated with a lateral compression type pelvic ring injury (OTA classification 61-C3.3a2, b2, c3) and left T-shaped acetabulum fracture (OTA classification 62-B2) in a 44-year-old male who was in a motorcycle accident. The testicular dislocation was noted during the emergency department primary survey, and its location and viability were verified with ultrasound. The testicle was isolated during surgical stabilization of the left acetabulum through a Pfannenstiel incision and modified-Stoppa approach and returned through the inguinal canal to the scrotum. In follow-up, the patient did not suffer urologic or sexual dysfunction. All motorcycle collision patients presenting with pelvic ring injuries or acetabulum fractures should be worked up for possible testicular dislocation with a scrotal exam. Advanced imaging and a urologic consult may be necessary to detect and treat these injuries.
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Halawi MJ. Pelvic ring injuries: Emergency assessment and management. J Clin Orthop Trauma 2015; 6:252-8. [PMID: 26566339 PMCID: PMC4600881 DOI: 10.1016/j.jcot.2015.08.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/14/2015] [Indexed: 01/26/2023] Open
Abstract
Pelvic ring injuries are associated with significant morbidity and mortality. Understanding the anatomy of the pelvic ring is essential for accurate diagnosis and treatment. A systematic approach taking into account the mechanism of injury, physical examination, and radiographic assessment is important to quickly identify unstable pelvic disruptions and associated injuries. Because the pelvis is a ring structure, isolated pubic rami fractures on plain radiographs are unusual and should warrant careful evaluation for posterior pelvic disruption with computed tomography. Hemorrhagic shock can occur in about 10% of pelvic ring injuries. Immediate recognition and treatment of this life-threatening condition is critical in emergency management. In addition to fluid resuscitation and blood transfusion, circumferential wrapping, angiographic embolization, laparotomy with pelvic packing, and external fixation can be important life-saving adjuncts in the setting of hemodynamic instability.
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Sexual dysfunction of male, after pelvic fracture. Eur J Trauma Emerg Surg 2015; 43:59-63. [DOI: 10.1007/s00068-015-0603-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
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Kostić I, Golubović I, Kocić B, Stojanović M. THE ASSOCIATION BETWEEN PELVIC FRACTURES (RING AND ACETABULUM FRACTURES) AND OTHER ORGAN SYSTEM INJURIES. ACTA MEDICA MEDIANAE 2015. [DOI: 10.5633/amm.2015.0304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Wu K, Posluszny JA, Branch J, Dray E, Blackwell R, Hannick J, Luchette FA. Trauma to the Pelvis: Injuries to the Rectum and Genitourinary Organs. CURRENT TRAUMA REPORTS 2015. [DOI: 10.1007/s40719-014-0006-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Odutola AA, Sabri O, Halliday R, Chesser TJS, Ward AJ. High rates of sexual and urinary dysfunction after surgically treated displaced pelvic ring injuries. Clin Orthop Relat Res 2012; 470:2173-84. [PMID: 22350654 PMCID: PMC3392396 DOI: 10.1007/s11999-012-2257-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2011] [Accepted: 01/12/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pelvic ring injuries may be associated with genitourinary injury (GUI) and result in urinary or sexual dysfunction. QUESTIONS/PURPOSES We determined (1) incidence of new sexual and urinary dysfunction after surgically treated pelvic ring injuries, (2) association of sexual or urinary dysfunction to fracture type and GUI, and (3) incidence and association between new sexual and urinary dysfunction in male and female patients without GUI. METHODS We retrospectively studied 151 patients by postal questionnaire after pelvic reconstruction. Presence, type, and severity of new sexual dysfunction and urinary dysfunction were related to GUI and type of pelvic fracture using the Young and Burgess classification. Minimum followup was 1 year (median, 5 years; range, 1-12 years). RESULTS New sexual dysfunction occurred in 61 of 143 (43%) and urinary dysfunction in 61 of 150 (41%) responding patients. Neither new sexual nor urinary dysfunction was associated with sex or GUI. In patients with no GUI, new sexual dysfunction was associated with chronologic age (odds ratio [OR], 1.04/year; 95% CI, 1.01-1.07) and pelvic fracture type. Lateral compression injury was less likely to result in new sexual or urinary dysfunction compared with AP type (sexual OR, 1.73; 95% CI, 0.67-4.47; urinary OR, 2.97; 95% CI, 1.15-7.66) and vertical shear type (sexual OR, 2.60; 95% CI, 1.02-6.64; urinary OR, 4.6; 95% CI, 1.81-11.73). CONCLUSIONS Our data suggest new sexual and urinary dysfunction occur at relatively high rates after pelvic fracture in patients with or without GUI. We recommend early assessment and referral for specialist treatment. LEVEL OF EVIDENCE Level III, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Adekoyejo A. Odutola
- Pelvic and Acetabular Reconstruction Unit, Frenchay Hospital, North Bristol NHS Trust, Bristol, BS16 1LE UK
| | - Omar Sabri
- Pelvic and Acetabular Reconstruction Unit, Frenchay Hospital, North Bristol NHS Trust, Bristol, BS16 1LE UK
| | - Ruth Halliday
- Pelvic and Acetabular Reconstruction Unit, Frenchay Hospital, North Bristol NHS Trust, Bristol, BS16 1LE UK
| | - Timothy J. S. Chesser
- Pelvic and Acetabular Reconstruction Unit, Frenchay Hospital, North Bristol NHS Trust, Bristol, BS16 1LE UK
| | - Anthony J. Ward
- Pelvic and Acetabular Reconstruction Unit, Frenchay Hospital, North Bristol NHS Trust, Bristol, BS16 1LE UK
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Ruatti S, Courvoisier A, Eid A, Griffet J. Ureteral injury after percutaneous iliosacral fixation: a case report and literature review. J Pediatr Surg 2012; 47:e13-6. [PMID: 22901936 DOI: 10.1016/j.jpedsurg.2012.03.065] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 03/04/2012] [Accepted: 03/10/2012] [Indexed: 11/28/2022]
Abstract
We report a case of right ureter injury in an 11-year-old girl after a percutaneous iliosacral screwing with non-computer-assisted fluoroscopic guidance. The indication was a pelvic ring fracture, C1-1 in the Tile modified AO classification (J Am Acad Orthop Surg. 1996;4:143-151). The mechanism was a ski accident. A percutaneous iliosacral screwing was performed to stabilize the right iliac wing fracture. Twelve days after the initial trauma, a right ureter tear was highlighted, just opposite the fourth lumbar vertebra. Uneventful spontaneous healing of the ureteral injury site occurred following double J-stent catheterization.
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Affiliation(s)
- Sébastien Ruatti
- Pediatric Orthopaedic Surgery Department, CHU de Grenoble, Hôpital Nord. 38700, La Tronche, France.
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Abstract
Injury to the genitourinary (GU) tract occurs in up to 10% of all traumas, with the kidneys being the most frequently affected. Trauma to different areas of the GU tract can be caused in a variety of ways, and the diagnostics and management of the injuries vary widely depending on the mechanism and location. Overall, fatalities from GU trauma are not common. However, significant morbidity can occur without prompt recognition and appropriate intervention. A basic understanding of urologic trauma is necessary for all emergency practitioners when caring for trauma patients.
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Affiliation(s)
- Sanjay Shewakramani
- Department of Emergency Medicine, Georgetown University Hospital, Washington, DC 20007, USA.
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Lückhoff C, Mitra B, Cameron PA, Fitzgerald M, Royce P. The diagnosis of acute urethral trauma. Injury 2011; 42:913-6. [PMID: 20739022 DOI: 10.1016/j.injury.2010.08.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 07/22/2010] [Accepted: 08/03/2010] [Indexed: 02/02/2023]
Abstract
BACKGROUND During trauma resuscitation, blind catheterization of an injured urethra may aggravate the injury by disrupting a partially torn urethra. In busy trauma centers, retrograde urethrograms (RUG) prior to catheterisation for all patients with unstable pelvic fractures presents a challenge during trauma resuscitation, and the procedure is not commonly practiced despite Advanced Trauma Life Support (ATLS) and World Health Organisation recommendations. The aim of this study was to determine the presenting clinical features of patients with urethral injuries and to predict major trauma patients needing further investigation to exclude this injury. METHODS A retrospective review of adult major trauma patients diagnosed with urethral injuries during an 8-year period at a major trauma centre, was conducted. RESULTS There were 998 major trauma patients with fractures of the pelvis over the study period, of whom 223 had pubic symphysis disruption. There were 29 patients with urethral injuries. The sensitivity of any one of the traditional signs of urethral trauma was 66.7% (95% CI: 46.0-82.8). After exclusion of patients with penetrating trauma and iatrogenic injuries, pubic symphysis disruption on initial pelvis AP X-ray and/or the clinical signs of urethral injury had a sensitivity of 100% (95% CI: 84.4-100.0) for urethral trauma. DISCUSSION Reliance on clinical features alone to predict urethral injury results in a substantial proportion of missed injuries in major trauma patients. RUGs did not appear to be needed in patients with no disruption of the pubic symphysis on initial pelvis X-ray or where no signs of urethral injury are present. In the absence of clinical signs and pubic symphysis disruption, blind urethral catheterisation may be attempted.
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Affiliation(s)
- Carl Lückhoff
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
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Abstract
BACKGROUND The anatomic support of the urethra is controversial. We present a case of an intact urethra and vagina avulsing from the symphysis pubis after pelvic fracture. CASE An 18-year-old female pedestrian was struck by a motor vehicle. Operative reevaluation revealed an intact vagina and urethra; however, they were avulsed from the symphysis pubis. The avulsed urethra and vagina were reapproximated to the periosteum and surrounding soft tissue circumferentially with no urogenital sequelae. CONCLUSION Complete anterior vaginal wall avulsion may occur with sparing of the lower urinary tract in the setting of pelvic fracture. This case supports the current anatomic understanding of a strong and dense attachment between the urethra and the anterior vaginal wall.
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Basta AM, Blackmore CC, Wessells H. Predicting urethral injury from pelvic fracture patterns in male patients with blunt trauma. J Urol 2007; 177:571-5. [PMID: 17222635 DOI: 10.1016/j.juro.2006.09.040] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Indexed: 11/23/2022]
Abstract
PURPOSE Precise definition of pelvic fracture location may enable prediction of which subjects are at risk for urethral injury and understanding of the pathophysiological mechanism of injury. We determined the specific anterior pelvic injury locations associated with urethral injury. MATERIALS AND METHODS We completed a retrospective, nested case-control study of 119 male patients evaluated at a single large level 1 trauma center between January 1, 1997 and July 15, 2003. We performed detailed measurements of the location, displacement and direction of force of each anterior pelvic fracture from computerized tomography and pelvic radiographs. Multiple logistic regression was used to determine associations between specific fracture locations and urethral injury after controlling for age, injury mechanism, injury severity and direction of force. RESULTS Urethral injury was present in 25 patients and all had anterior pelvic fracture (inclusive of pubic symphysis diastasis). There were no urethral injuries in patients with fractures isolated to the acetabulum. Pelvic fractures that were independently associated with urethral injury from multiple regression analysis included displaced fractures of the inferomedial pubic bone, OR 6.4 (95% CI 1.6 to 24.9), and symphysis pubis diastasis, OR 11.8 (95% CI 4.0 to 34.5). Each millimeter of symphysis pubis diastasis or inferomedial pubic bone fracture displacement was associated with an approximately 10% increased risk of urethral injury. CONCLUSIONS The location and displacement of anterior pelvic fractures in males predict risk of urethral injury and may be valuable in determining when evaluation of the urethra is appropriate.
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Affiliation(s)
- Amaya M Basta
- Department of Radiology, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, Washington 98104, USA
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Tauber M, Joos H, Karpik S, Lederer S, Resch H. Urogenitale Begleitverletzungen bei Beckenringfrakturen. Unfallchirurg 2007; 110:116-23. [PMID: 17123043 DOI: 10.1007/s00113-006-1206-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Follow-up of patients with pelvic ring fractures and associated injuries of the lower urogenital tract was performed from January 2000 to October 2004. Analysis focused on incidence, fracture type, type of urogenital injury, associated intrapelvic lesions, mortality, and urologic outcome. METHOD AND RESULTS The retrospective study included 18 of 111 patients (16.2%). Nine patients had a rupture of the urethra, six a rupture of the bladder, three a rupture of the penile root, and two a gonadal defect. The type of the pelvic ring fracture according to the AO classification was type A in 1, type B in 6, and type C in 11 cases. Fifteen patients (83.3%) were followed up clinically for a mean duration of 26 months (range: 12-66 months) after trauma. Seven patients were asymptomatic concerning the urogenital injury, five had erectile dysfunction, two had urethral stenosis, in one case associated with incontinence, and one patient with bilateral defect of the testicles was under hormone substitution therapy. CONCLUSION Urogenital injuries, often associated with intrapelvic lesions in so-called complex pelvic trauma, are typical for high-grade pelvic ring fractures and have an essential prognostic value for the patient's morbidity and quality of life.
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Affiliation(s)
- M Tauber
- Universitätsklinik für Unfallchirurgie und Sporttraumatologie, Salzburg, Osterreich.
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Ziran BH, Chamberlin E, Shuler FD, Shah M. Delays and difficulties in the diagnosis of lower urologic injuries in the context of pelvic fractures. ACTA ACUST UNITED AC 2005; 58:533-7. [PMID: 15761348 DOI: 10.1097/01.ta.0000152561.57646.80] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This article describes the characteristics of missed lower urologic injuries at a level 1 trauma center using advanced trauma life support protocols. Between 1991 and 1996, 635 patients were treated for traumatic pelvic fractures. For the 43 patients with missed urologic diagnoses, the pelvic fracture pattern, initial evaluation, average delay to diagnosis and treatment, reason for the delay, and manner in which the lower urinary tract injury was discovered and treated were identified. RESULTS Of 43 patients with pelvic fracture, 10 (23%) with concomitant urologic injury had initially missed diagnoses. Delay in diagnosis and treatment averaged 19 hours for missed intraperitoneal bladder ruptures and 6.7 days for missed extraperitoneal bladder ruptures. CONCLUSION The findings show that 23% of all bladder and urethral disruptions associated with pelvic fractures were missed at initial evaluation. The pelvic fracture pattern, in addition to physical examination, should direct the urologic evaluation for trauma patients.
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Heinermann JDB, Hessmann MH, Rommens PM. Akzidentelles Seitspagat als Ursache eines komplexen Beckentraumas. Unfallchirurg 2005; 108:319-21. [PMID: 15756528 DOI: 10.1007/s00113-004-0861-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Complex pelvic ring fractures are defined as injuries of the pelvic ring in association with lesions of the pelvic organs or the pelvic soft tissues. These injuries are typically caused by high-energy accidents. In contrast to the typical mechanism of injury a case is described in which a low energy trauma led to a complex pelvic ring trauma. An obese woman suffered an open-book injury of the pelvis with severe open urogenital soft-tissue damage by accidentally doing forced splits. Primary stabilization of the pelvic ring with external fixation and secondary internal fixation with a double-plate osteosynthesis of the symphysis led to a good clinical outcome concerning the osseous lesion. The urogenital injuries with rupture of the bladder, the urethra and the vagina led despite immediate urological management to an incontinence, which finally required definitive urine drainage via an ileum conduit.
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Affiliation(s)
- J D B Heinermann
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Mainz.
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Abstract
Fifty-one male patients with prior pelvic fracture completed a Brief Sexual Function Inventory questionnaire (BSFI) 2 years postinjury. Responses were compared to those of 53 men with ankle fractures. Patients with pelvic fracture scored significantly worse than patients with ankle fracture. Patients with pelvic fracture scored poorly on sex drive, erection, ejaculation, and satisfaction with sex life. Older patients had significantly worse sex function scores than younger patients. Sexual dysfunction is common after pelvic fracture, and many facets of sex life are affected. The BSFI was well accepted, and is a useful screening tool for identifying patients with sexual dysfunction.
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Affiliation(s)
- Donald Ozumba
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex 75390-8883, USA
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Abstract
The objectives of this study are to describe the anatomic findings relative to anterior pelvic endoscopy, determine the potential use of endoscopy for reduction and fixation of fractures of the anterior pelvic ring, and report two illustrative cases performed using this method. Using the windows described, endoscopy permits placement of plates and screws on top of the symphysis pubis, reduction of internally displaced fragments, and performance of percutaneous procedures that do not harm anatomic structures.
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Affiliation(s)
- Iván Federico Rubel
- Department of Orthopedic Surgery, University of Louisville Hospital, Louisville, Kentucky 40292, USA
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Rommens PM, Hessmann MH. Staged reconstruction of pelvic ring disruption: differences in morbidity, mortality, radiologic results, and functional outcomes between B1, B2/B3, and C-type lesions. J Orthop Trauma 2002; 16:92-8. [PMID: 11818803 DOI: 10.1097/00005131-200202000-00004] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To analyze injury pattern, surgical therapy, radiologic results, and functional outcome in unstable B-type and C-type pelvic ring fractures. DESIGN Retrospective study. SETTING Level I University Trauma Center. PATIENTS Two-hundred-twenty-two consecutive patients, admitted during a nine-year period with unstable B-type (n = 100) and C-type (n = 122) pelvic ring injuries, of whom 122 (61.3 percent of surviving patients) were eligible for evaluation with a minimum follow-up of one year. INTERVENTIONS Staged reconstruction dependent upon injury pattern. Emergency external compression of the pelvic ring in case of hemodynamic instability. Management of associated lesions. Secondary open reduction and internal fracture fixation. MAIN OUTCOME MEASURES Assessment of perioperative and postoperative mortality and morbidity depending on fracture pattern. Fifty-five B-type and sixty-seven C-type lesions were evaluated clinically and radiologically an average of 21.6 months after trauma. RESULTS Perioperative mortality was 5 percent in B-type and 15 percent in C-type fractures. External fixation was part of the definitive treatment in 52 percent of B-type and in 38 percent of C-type lesions. Planned secondary operative procedures were performed in 15 percent of B-type and in 26.2 percent of C-type fractures. Radiologic results were anatomic in 93.5 percent of B1, 75 percent of B2/B3, and 62.7 percent of C-type lesions. Functional results were excellent or good in 74 percent of the B1, 92 percent of the B2/B3, and in 71 percent of the C-type fractures. CONCLUSIONS Unstable pelvic ring fractures require a staged approach. Mortality is higher in C-type than in B-type lesions. Functional outcome is worse in C-type than in B-type lesions. Within the B-type group, B1 lesions have a worse functional end result than B2/B3 fractures. These findings are not only related to the stability and symmetry of the pelvic ring, as seen in the radiologic picture, but also depend on the severity and amount of damage to the soft tissues around the pelvis.
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Affiliation(s)
- P M Rommens
- Department of Trauma Surgery, Hospital of the Johannes Gutenberg--University of Mainz, Federal Republic of Germany
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Abstract
Injuries to the GU system commonly occur in patients with high-energy lower abdominal or pelvic trauma. The emergency physician should be well versed in the diagnosis and management of GU trauma, although these injuries are not usually life threatening because of the potential for loss of urinary or sexual function. In the setting of hemodynamic instability, diagnosis and treatment of GU injuries is often accomplished in the operative setting. In the stable patient, diagnostic testing is directed by the type of suspected injury and must proceed in a reverse manner, i.e., external injury then urethral injury then bladder, and finally urethral and renal damage. Treatment focuses on a team approach between the emergency physician, general, orthopedic, and urologic surgeon. The decision for operative repair is often dictated more by other associated injuries than urologic injuries, and the urologic surgeon often provides temporizing measures with definitive repair at a later time. Prompt diagnosis and treatment of injuries to the external genitals results in excellent long-term outcome, minimizing the devastating consequences of impotence, urinary incontinence, and sexual disfiguration.
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Affiliation(s)
- D A Dreitlein
- Department of Emergency Medicine, Rhode Island Hospital, Brown University School of Medicine, Providence, Rhode Island, USA
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Lodgea RN. The management of urethral trauma. TRAUMA-ENGLAND 2000. [DOI: 10.1177/146040860000200107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Urethral trauma is relatively uncommon. It occurs more frequently in young males. Injuries to the a nterior urethra are typically caused by blunt trauma including 'straddle' injuries, athough penetrating injuries do occur. Posterior urethral injurines are usually due to pelvic fractures from automobile or industrial accidents and occur in 10% of patients with a pelvic fracture. In addition to reviewing the management options available in this group of innjuries and highlighting areas of controversy, this article offers clear advice on the initial management of these innjuries on presentation in the emergency department. Subsequent definitive management depends on a variety of factors: the nature and size of the urethral innjury the extent and priorities of treatment of any associated injuries, the availability of local expertise and equipment for dealing with injuries of this type and the management philosophy of the clinical teams involved.
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Affiliation(s)
- R N Lodgea
- Department of Urology, Royal United Hospital, Bath, UK,
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Abstract
Careful radiographic assessment is essential in the diagnosis of pelvic fractures. The standard radiographic assessment of the pelvis includes the anteroposterior, inlet, outlet, Judet views, and axial computed tomography images. The different radiographic projections of the pelvis and their corresponding anatomic landmarks and the anatomy of the pelvis and the different anterior and posterior pelvic lesions are discussed. Description of the proper views and their uses are included.
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