UROLOGICAL COMPLICATIONS IN PELVIC FRACTURES: CORRELATION BETWEEN TYPES OF FRACTURES AND URINARY INJURIES

Year 2021, Volume: 4 Issue: 2, 64 - 69, 31.08.2021

Recep Dinçer , Sefa Alperen Öztürk

Abstract

Purpose: The aim of the study was to investigate radiological findings, specific pelvic fractures and urological injuries accompanying fractures of the pelvic region.

Material and Method: Patients with pelvic fracture who applied to the emergency department between January 2013 and December 2019 and were admitted to orthopedics and traumatology clinic were retrospectively screened. Pelvic fractures were typed according to Tile classification using the hospital’s registration system. The present study include 62 patients with pelvic trauma (44 men, 18 women), who were consulted with the urology clinic upon their admission by the emergency department and then followed up by the urology clinic upon their hospitalization.

Results: The mean age of patients is 48 (7-90). 26 cases (47.6%) were in-vehicle traffic accident (IVTA), 14 cases (22.2%) extravehicular traffic accident (EVTA), 2 cases (1.6%) motorcycle accident, 16 cases (25.4%) fall down from height, 2 cases occupational accidents, and 2 cases accidents due to other causes. The most common pelvic fractures are Tile A2, B2 and B1. The most common accompanying finding in urogenital injuries is unexplained microhematuria (20.6%) and macrohematuria (22.2%). The most common types of pelvic fractures accompanied by urogenital injuries are Tile Types A2 and B2. There is a significant relation between types of pelvic fractures and urogenital injuries.
Conclusion: Pelvic ring injuries are injuries with high mortality and morbidity, which are often caused by high-energy injuries. Therefore, in order to minimize mortality and morbidity, a quick and aggressive approach is required for diagnosis and treatment in emergency services. Detection of the specific fracture pattern will also facilitate the detection of additional concomitant urological injury, which will create a chance for early intervention.

Keywords

Macrohematuria, Bladder injury, Microhematuria, Pelvic fracture, Tile Classification.

References

• 1. Tile M. Pelvic ring fractures: should they be fixed?. J Bone Joint Surg Br. 1988;70:1-12.
• 2. Dalinka MK, Arger P, Coleman B. CT in pelvic trauma. Orthop Clin North Am. 1985;16:471-80.
• 3. Tscherne H, Regel G, Pape HC, Pohlemann T, Krettek C. Internal fixation of multiple fractures in patients with polytrauma. Clin Orthop Relat Res. 1998;347:62-78.
• 4. Alost T, Waldrop RD. Profile of geriatric pelvic fractures presenting to the emergency department. Am J Emerg Med. 1997;15:576-8.
• 5. Güloğlu R, Kocataş A, Asoğlu O, Alış H, Arıcı C, Türel Ö. Urologic injuries. Ulus Travma Acil Cerrahi Derg. 1996;2:43-6.
• 6. Dalal AK, Sinha TP, Mohanty D. Pelvic Fractures and Urogenital Injuries. Journal of Orthopaedics, Traumatology and Rehabilitation. 2014;7:29-32.
• 7. Cooperberg MR, McAninch JW, Alsikafi NF, Elliott SP. Urethral reconstruction for traumatic posterior urethral disruption: Outcomes of a 25-year experience. J Urol. 2007;178:2006-10.
• 8. Buyukcam F, Sen J, Akpinar S, Zengin Y, Calik M, Odabas O. Evaluation of urogenital injuries in patients with trauma in the emergency department. Ulus Travma Acil Cerrahi Derg. 2012;18:133-40.
• 9. Bjurlin MA, Fantus RJ, Mellett MM, Goble SM. Genitourinary injuries in pelvic fracture morbidity and mortality using the National Trauma Data Bank. J Trauma. 2009;67:1033-9.
• 10. Koraitim MM, Marzouk ME, Atta MA, Orabi SS. Risk factors and mechanism of urethral injury in pelvic fractures. Br J Urol. 1996;77:876-80.
• 11. Yildirim C, Yuksel OH, Akan S, Urkmez A, Verit A. Lower pole renal cut injury due to the iliac wing fracture: A rare case report. Arch Ital Urol Androl. 2015;87:179-80.
• 12. Moore EE, Shackford SR, Pachter HL, McAninch JW, Browner BD, Champion HAT, et al. Organ Injury Scaling: Spleen, Liver, and Kidney. J Trauma. 1989;29:1664-6.
• 13. Haroon SA, Rahimi H, Merritt A, Baghdanian A, Baghdanian A, LeBedis CA. Computed tomography (CT) in the evaluation of bladder and ureteral trauma: indications, technique, and diagnosis. Abdom Radiol (NY). 2019;44:3962-77.
• 14. Kong JP, Bultitude MF, Royce P, Gruen RL, Cato A, Corcoran NM. Lower urinary tract injuries following blunt trauma: a review of contemporary management. Rev Urol. 2011;13:119-30.
• 15. Guttmann I, Kerr HA. Blunt bladder injury. Clin Sports Med. 2013;32:239-46.
• 16. Pereira BMT, Campos CCC, Calderan TRA, Reis LO, Fraga GP. Bladder injuries after external trauma: 20 years experience report in a population-based cross-sectional view. World J Urol 2013;31:913-7.
• 17. Johnsen NV, Dmochowski RR, Young JB, Guillamondegui OD. Epidemiology of Blunt Lower Urinary Tract Trauma With and Without Pelvic Fracture. Urology. 2017;102:234-9.
• 18. McGeady JB, Breyer BN. Current epidemiology of genitourinary trauma. Urol Clin North Am. 2013;40:323-34.
• 19. Anderson RE, Keihani S, Moses RA, Nocera AP, Selph JP, Castillejo Becerra CM, et al. Current Management of Extraperitoneal Bladder Injuries: Results from the Multi-Institutional Genito-Urinary Trauma Study (MiGUTS). J Urol. 2020:101097JU0000000000001075.
• 20. Lee MJ, Wright A, Cline M, Mazza MB, Alves T, Chong S. Pelvic Fractures and Associated Genitourinary and Vascular Injuries: A Multisystem Review of Pelvic Trauma. AJR Am J Roentgenol. 2019;213:1297-306.
• 21. Deibert CM, Spencer BA. The association between operative repair of bladder injury and improved survival: results from the National Trauma Data Bank. J Urol. 2011;186:151-5.
• 22. Matlock KA, Tyroch AH, Kronfol ZN, McLean SF, Pirela-Cruz MA. Blunt traumatic bladder rupture: a 10-year perspective. Am Surg. 2013;79:589-93.
• 23. Barratt RC, Bernard J, Mundy AR, Greenwell TJ. Pelvic fracture urethral injury in males-mechanisms of injury, management options and outcomes. Transl Androl Urol. 2018;7(Suppl 1):S29-S62.
• 24. Mundy AR, Andrich DE. Urethral trauma. Part I: introduction, history, anatomy, pathology, assessment and emergency management. BJU Int. 2011;108:310-27.
• 25. Zou Q, Zhou S, Zhang K, Yang R, Fu Q. The Immediate Management of Pelvic Fracture Urethral Injury-Endoscopic Realignment or Cystostomy? J Urol. 2017;198:869-74.
• 26. Horiguchi A, Shinchi M, Masunaga A, Okubo K, Kawamura K, Ojima K, et al. Primary Realignment for Pelvic Fracture Urethral Injury Is Associated With Prolonged Time to Urethroplasty and Increased Stenosis Complexity. Urology. 2017;108:184-9.