Internal Fixation in Pelvic Fractures and Primary Repairs of Associated Genitourinary Disruptions: A Team Approach

• Published in: The Journal of Trauma: Injury, Infection, and Critical Care Vol. 40; no. 5; pp. 784 - 790
• Main Authors: Routt, M. L. Chip, Simonian, Peter T., Defalco, Alfred J., Miller, Jane, Clarke, Todd
• Format: Journal Article
• Language: English
• Published: Baltimore, MD Williams & Wilkins 01-05-1996; Lippincott Williams & Wilkins
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Clinical Protocols; Female; Follow-Up Studies; Fracture Fixation, Internal - methods; Fractures, Bone - complications; Fractures, Bone - surgery; Humans; Injuries of the urinary system. Foreign bodies. Diseases due to physical agents; Joint Dislocations - complications; Joint Dislocations - surgery; Male; Medical sciences; Middle Aged; Orthopedics; Patient Care Team - organization & administration; Pelvic Bones - injuries; Traumas. Diseases due to physical agents; Treatment Outcome; Urethra - injuries; Urinary Bladder - injuries; Urology; Human; Open reduction; Urinary system disease; Diseases of the osteoarticular system; Pelvis minor; Rupture; Fracture; Urinary tract disease; Trauma; Urogenital; Genital diseases; Result; Concomitant disease; Treatment; Surgery; Pelvis pathology; Technique
• ISSN: 0022-5282; 1529-8809
• DOI: 10.1097/00005373-199605000-00018

Associated urological and orthopedic injuries of the pelvic ring are complex with numerous potential complications. These patients are treated optimally using a team approach. The combined expertise is not only helpful initially when managing these difficult patients, but also later as problems develop. This study describes a treatment protocol and reports the early results of 23 patients with unstable pelvic fractures and associated bladder or urethral disruptions, or both, treated surgically with open reduction and internal fixation of the anterior pelvic ring injuries at the same anesthetic and using the same surgical exposure as the urethral realignments or bladder repairs or both. Early complications occurred in four patients (17%)one patient sustained a fifth lumber nerve injury caused by the plevic reduction procedure, and three patients had anterior pelvic internal fixation failures. Late complications occurred in eight patients (35%). There was one deep wound infection (4.3%) that presented 6 weeks after injury. Late urological complications occurred in seven patients (30%). Four of the nine male patients with urethral disruptions had urethral stricture after their primary urethral realignments (44%). Three of the 18 male patients admitted to impotence (16.7%). One of the three had a residual thoracic paraplegia caused by a burst fracture. One of the five female patients had urinary incontinence and required a bladder suspension operation to restore normal function (20%). A low infection rate can be expected despite the use of internal fixation. Early urethral "indirect" realignments avoid more difficult delayed open repairs; however, late urological complication rates are still high. Early "direct" bladder repairs are easily performed at the time of anterior pelvic open reduction and internal fixation. Suprapubic tubes are not necessary to adequately divert the urine when large diameter urethral catheters are used in these patients.