Extraperitoneal Bladder Injuries Associated With Pelvic Fracture Requiring Internal Fixation: What Is the Evidence?

Khabiri, Seyyed Saeed; Keihani, Sorena; Myers, Jeremy B.

doi:10.1177/0003134820956342

Cited by 10 publications

(6 citation statements)

References 32 publications

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“…Support for cystorrhaphy stems from concern for pelvic hardware infection or bladder leak on repeat imaging. 2,7 Yao et al performed a retrospective review of 45 patients with bladder injuries who underwent internal fixation of pelvic fractures. The authors found hardware infection was significantly lower in patients managed with cystorrhaphy compared to non-operative management (5% vs 33.3%).…”

Section: Discussionmentioning

confidence: 99%

Management of Extraperitoneal Bladder Injuries in Patients With Pelvic Fractures

Byars,

Byerly,

Dong

et al. 2024

The American Surgeon™

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Background The management of extraperitoneal bladder injuries (EBIs) when present with concomitant pelvic fractures is controversial. Current evidence is divided between supporting non-operative management with catheter drainage compared to operative management of bladder injury. The purpose of this study was to evaluate current management of EBI in the setting of pelvic fractures at our institution. We hypothesize there is no difference between operative and non-operative groups. Methods Retrospective review of patients with concomitant bladder injuries and pelvic fractures at a level 1 trauma center from 2017 to 2022 was performed. Demographics, injury characteristics, management strategies, and complications were collected. Patients were stratified by management (cystorrhaphy vs non-operative) and compared. Results Of 90 patients with bladder injuries and pelvic fractures, 50 patients (56%) presented with EBI, 26 patients (29%) presented with only intraperitoneal injuries, and 14 patients (16%) presented with a combined injury. Of patients with EBI, 18 (36%) underwent cystorrhaphy and 32 (64%) underwent non-operative management. There was no difference in demographics, orthopedic pelvic operative intervention, length of stay, or mortality between groups. Patients in the operative cohort had more bladder leaks [7 (39%) vs 4 (13%), P = .0406], compared to those in the non-operative cohort. Composite complications [7 (39%) vs 7 (22%), P = .1984] were similar between groups. Conclusions Patients with EBI and pelvic fractures who underwent cystorrhaphy had more bladder leaks on follow-up imaging, although there was no difference in composite complications, when compared to those who underwent non-operative management.

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Section: Discussionmentioning

confidence: 99%

Management of Extraperitoneal Bladder Injuries in Patients With Pelvic Fractures

Byars,

Byerly,

Dong

et al. 2024

The American Surgeon™

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“…Intraperitoneal bladder injuries usually need surgical repair, whereas extraperitoneal lesions can be managed nonoperatively by treating them with a transurethral catheter. Concern for pelvic hardware contamination is one of the most common reasons for repairing extraperitoneal bladder injuries, but some authors believe that extraperitoneal should not affect the decision about open fracture surgery (36).…”

Section: Immediate Stabilization Of Open Pelvic Fractures In Stable P...mentioning

confidence: 99%

Immediate management of a stable patient with unstable pelvis

Cano,

Bogallo,

Ramirez

et al. 2024

EFORT Open Reviews

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The diagnosis of a traumatic unstable pelvis in a stable patient is a temporary concept depending on when we see the patient, as all patients presenting with hemorrhagic shock have hemodynamic stability until they become unstable. As a rule, the more unstable the pelvic fracture is, the higher the risk of bleeding and hemodynamic instability it has. Therefore, in unstable pelvic fractures, hemodynamic stability should be a diagnosis by exclusion. For bleeding detection in stable patients, an immediate one-stage contrast-enhanced CT scan is the appropriate diagnosis test; however, since CT scan radiation is always an issue, X-rays should be considered in those cases of hemodynamically stable patients in whom there is a reasonable suspicion that no unsafe bleeding is going on. Pelvic fracture classification is essential as usually there is an association between the injury mechanism, the fracture displacement, and the hemodynamic stability. Anteroposterior and, particularly, vertical traumatisms have much more proclivity to provoke major pelvic displacement and bleeding. The use of a pelvic binder, as early as possible including pre-hospital management, should be standard in high-impact blunt trauma patients independently of the trauma mechanisms. External fixation is the preferred method of stabilization in case of open fractures, and, in closed ones, when the schedule for definite osteosynthesis prolongs because of the patient’s general condition. If possible, immediate percutaneous sacroiliac screw insertion for unstable pelvic fractures produce excellent results even in open fractures.

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“…3 However, surgical repair may be indicated in the setting of complex bladder injury, concurrent exploratory laparotomy, fracture fragment abutment of the bladder, or open fixation of pelvic fractures. 4,5 Certain bladder injuries may extend through both the IP and extraperitoneal regions.…”

Section: Introductionmentioning

confidence: 99%

Does anterior plating of pelvic ring fractures increase infection risk in patients with bladder or urethral injuries?

Medda,

Cuadra,

et al. 2023

Journal of Orthopaedic Trauma

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OBJECTIVES: Evaluate the effect of anterior fixation on infection in patients with operative pelvic fractures and bladder or urethral injuries. METHODS: Design: Retrospective Setting: Eight centers Patient Selection Criteria: Adult patients with closed pelvic fractures with associated bladder or urethral injuries treated with anterior plating (AP), intramedullary screw (IS) or no anterior internal fixation (NAIF, including external fixation or no fixation) Outcome Measures and Comparisons: Deep infection RESULTS: There were 81 extraperitoneal injuries and 57 urethral injuries. There was no difference in infection between fixation groups across all urologic injuries (AP: 10.8%, IS: 0%, NAIF: 4.9%, p = 0.41). There was a higher rate of infection in the urethral injury group compared to extraperitoneal injuries (14.0% vs 2.5%, p = 0.016). Among extraperitoneal injuries specifically, there was no difference in deep infection related to fixation (AP: 2.6%, IS 0%, NAIF: 2.9%, p = 0.99). Among urethral injuries, there was no statistical difference in deep infection related to fixation (AP: 23.1%, IS: 0%, NAIF: 7.4%, p = 0.21). There was a higher rate of suprapubic catheter (SPC) use in urethral injuries compared to extraperitoneal injuries (57.9% vs 4.9%, p < 0.0001). In the urethral injury group, SPC use did not have a statistically significant difference in infection rate (SPC: 18.2% vs No SPC: 8.3%, p = 0.45). Early removal of the SPC before or during the definitive orthopedic intervention did not significantly effect infection rate (Early: 0% vs Delayed: 25.0%, p = 0.16). CONCLUSIONS: Surgeons should approach operative pelvic fractures with associated urologic injuries with caution given the high risk of infection. Further work must be done to elucidate the effect of anterior implants and suprapubic catheter use and duration.

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Extraperitoneal Bladder Injuries Associated With Pelvic Fracture Requiring Internal Fixation: What Is the Evidence?

Cited by 10 publications

References 32 publications

Management of Extraperitoneal Bladder Injuries in Patients With Pelvic Fractures

Management of Extraperitoneal Bladder Injuries in Patients With Pelvic Fractures

Immediate management of a stable patient with unstable pelvis

Does anterior plating of pelvic ring fractures increase infection risk in patients with bladder or urethral injuries?

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