Testicular Dislocation After Unstable Pelvic Ring Injury

Abstract

Reproductive and genitourinary complications following pelvic ring injuries have been described; however, testicular dislocation is rare and can cause significant morbidity if not managed appropriately. We describe a case of testicular dislocation after pelvic ring injury and outline the subsequent management and outcome, and seek to identify areas of improvement to ensure expedient and appropriate care in the setting of these injuries. Our case describes a 29-year-old male who presented to a level-one trauma center following a motorcycle collision. An anteroposterior compression type II rotationally unstable pelvic ring was identified on imaging. He was hemodynamically unstable and computed tomography (CT) with angiography was ordered. Arterial extravasation was noted from the bilateral anterior internal iliac arteries, which were subsequently embolized by interventional radiology. However, no concomitant genitourinary injury was identified at the time of CT. After resuscitation, the pelvis was stabilized with an anterior symphyseal plate and bilateral sacroiliac screws. During the anterior pelvic approach, the patient’s dislocated testicle was surprisingly discovered inferior to the pubis. Urology was consulted intra-operatively, and the testicle was successfully relocated. At the final follow-up, the pelvic ring was healed without any noticeable urogenital complication. While testicular dislocation has been reported in the setting of pelvic ring injury, a paucity of information exists regarding management, implications, and areas for improvement in the identification of these injuries. Therefore, in cases of pelvic ring injury with significant trauma, radiologists, traumatologists, and orthopedic surgeons should adopt a multi-disciplinary approach in diligently attempting to rule out testicular dislocation pre-operatively. Intra-operatively, examination under anesthesia and careful operative technique are important in preventing iatrogenic injury.

Assessment and management of pelvic fractures from high-energy trauma in adults

“…Blood from the urethral meatus, genitals or rectum are signs of urological or colorectal injuries [Wong and Bucknill, 2017]. Swelling, bruising and haematomas to the scrotum or perineum can be signs of testicular dislocation and internal injury, as can inguinal and abdominal pain [Bernhard et al 2021].…”

Traumatic testicular dislocation

“…Matzek and Linklater [38] 1 Blunt abdominopelvic injury PE, US 33 Meena et al [39] 1 MA PE, US 34 Zavras et al [40] 1 Falling astride on a crossbar PE, US 35 Gómez et al [41] 7 6 MAs 1 pelvic crush injury PE, US, autopsy(2) 36 Pesch and Bradin [42] 1 Straddle injury US 37 Wiznia et al [43] 1 MA PE, US 38 Kim et al [44] 1 construction accident CT 39 de Carvalho et al [6] 1 MA PE, US 40 Shirono et al [12] 1 Falling down US, MRI 41 Middleton et al [45] 2 M A C T 42 Riaza Montes et al [3] 1 Uncertain (alcohol abuse) PE, US 43 Bernhard et al [46] 1 MA During OP 44…”