Pelvic fracture urethral injury - the nature of the causative injury correlates strongly with surgical treatment and outcome
BAUS ePoster online library. Ivaz S.
Jun 26, 2018; 211357
Ms. Stella Ivaz
Ms. Stella Ivaz
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Abstract
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Introduction: We have assessed the specific nature of the trauma leading to pelvic ring disruption and its relationship to the resulting urethral injury, its surgical treatment and outcome.

Patients and Methods: 106 consecutive patients were evaluated. 66 patients (62%) were involved in a road traffic accident (n=33 driver / passenger in a car), 38(36%) in work / recreational activities. 2 patients (2%) attempted suicide by jumping.

Results: Car accidents - lateral compression (LC) fractures n=27, open-book(OB) n=4; Motorcycle\bicycle accidents - LC n=16, OB n=12, vertical shear disruptions(VS) n=4; Work\recreational accidents - LC n=23, OB n=11, VS n=4. The remaining 4 were unclassifiable in this simple way.
Of 69 LC fractures, 34 were “straightforwards” (car injuries n=30, pedestrians n=2, work injuries n=2, not easily classifiable n=13) and 22 were crush injuries (car injury n=1, pedestrians n=18, work injury n=3). The other 13 were not easily classifiable.
Surgery (bulbo-prostatic anastomosis) was mobilisation and anastomosis in 15%, crural separation in 52.5%, inferior pubectomy in 15% and supra-crural re-routing in 17.5%. 60% of the pubectomy cases and 67% of the re-routing patients were crush injuries.

Conclusion: Car drivers and passengers tended to have less serious injuries and better outcome mainly because LC fractures seemed to cause less local pelvic trauma and were associated with shorter defects to bridge. Specifically there was an 88% chance that the injury would be a “straightforward” LC injury causing an incomplete rupture with a 92% chance that it can be treated by a step 1 or step 2 BPA.
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