Pelvic Fractures and Associated Genitourinary and Vascular Injuries: A Multisystem Review of Pelvic Trauma

Lee, Michael J; Wright, Adam; Cline, Michael; Mazza, Michael B.; Alves, Timothy; Chong, Suzanne T.

doi:10.2214/ajr.18.21050

Cited by 23 publications

(18 citation statements)

References 56 publications

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“…The choice of conservative or surgical management depends on the patient's condition and the size of the hematoma. Small hematomas without acute expansion can be managed conservatively by administering analgesics and antibiotics [ 2 ]; however, conservative management may require longer hospital stays, and is associated with an increased need of antibiotics and blood transfusion [ 8 ]. If the hematoma grows larger and the pain persists, surgical intervention is usually recommended [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Large traumatic vulvar hematoma managed with a simple incision: A case report

Tjokroprawiro

2021

International Journal of Surgery Case Reports

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Introduction and importance Non-obstetric vulvar hematoma is a rare condition. With only few cases reported, no standard consensus exists on the best management of vulvar hematomas. Herein, we report the successful management of a large trauma-induced vulvar hematoma through a simple incision under local anesthesia. Localized large vulvar hematomas can be treated with this simple procedure. Case presentation A 38-year-old woman presented with vulvar pain following a fall. Investigations revealed a large painful hematoma in the right labium majus. Imaging revealed that the hematoma was localized and the pelvic structure was normal. We successfully treated the hematoma by making an incision in the right labium majus under local anesthesia to evacuate the clot and ligate the bleeding points. She was discharged in a good condition after two days. Discussion Non-obstetrics vulvar hematoma is rare particularly the large hematoma. A blunt trauma may cause a large vulvar hematoma. There is no standard management of vulvar hematomas since the incidence is very low. The important step in managing vulvar hematoma is detecting the localization of the hematoma and evaluating other pelvic structures. Most of vulvar hematoma is isolated in the soft tissue around the labium majus and the vagina without further extension. After confirming that the large vulvar hematoma is localized and there are no injuries to the other pelvic structures, a simple incision and bleeding points ligation under local anesthesia can be performed to relieve the pain and prevent pressure necrosis. Conclusion Simple incision under local anesthesia is effective for managing large vulvar hematomas and reduces the recovery time.

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Section: Discussionmentioning

confidence: 99%

Large traumatic vulvar hematoma managed with a simple incision: A case report

Tjokroprawiro

2021

International Journal of Surgery Case Reports

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“…Pelvic fractures are often caused by high-energy injuries, often accompanied by abdominal organs, blood vessels, nerve injuries, and with many complications and high mortality [1][2][3][4]. Once the pelvic fracture affects the integrity of ligaments and muscle structures, the stability of the sacroiliac joint will also be destroyed, causing the posterior ring of the pelvis to become unstable [5].…”

Section: Introductionmentioning

confidence: 99%

Comparison of percutaneous cross screw fixation versus open reduction and internal fixation for pelvic Day type II crescent fracture-dislocation: case-control study

et al. 2021

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Objective To investigate the clinical outcomes of percutaneous cross screws internal fixation for pelvic Day type II crescent fracture-dislocation. Methods We reviewed 66 consecutive patients undergoing surgical treatment for Day type II crescent fracture-dislocation from June 2005 to December 2017. Percutaneous cross screws internal fixation was performed in 40 patients, and open reduction and internal fixation was performed in 26 patients. The patient characteristics, surgical complications, radiographic and clinical outcomes and were compared. Results There was no statistically difference on the mean time from injury to surgery between the two groups. The time of operation, the amount of blood loss, the length of incision, and the hospital stay were significantly shorter in the percutaneous cross screws internal fixation group. No significant difference on Matta scores and Majeed scores between the two groups. The open reduction and internal fixation group resulted in a higher rate of intraoperative hemorrhage, nerve injury, discomfort, and pain. Conclusion Percutaneous cross screws internal fixation for Day II type pelvic crescent fracture-dislocation was safe and effective. Minimally invasive fixation had the advantages of short operation and hospitalization time, less intraoperative bleeding, and surgical trauma.

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“…Additionally, a study demonstrated that approximately 25% of patients with pelvic ring disruption had lower urinary tract injuries. Recently, a systematic review revealed that approximately 29% of patients with pelvic fracture presented with genitourinary (bladder, urethra, and ureter) injuries [ 8 ]. These patients had potential urine contamination and urinary tract infections (UTIs).…”

Section: Introductionmentioning

confidence: 99%

Risk of Mortality and Readmission among Patients with Pelvic Fracture and Urinary Tract Infection: A Population-Based Cohort Study

Chen

Chuang

Hsieh

et al. 2021

IJERPH

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Patients with pelvic fractures could encounter various complications during or after treatments. This cohort study investigated the risk of mortality and readmissions in patients with pelvic fractures, with or without urinary tract infections (UTIs), within 30 days following the pelvic fractures. This retrospective cohort study examined claim records from the Longitudinal Health Insurance Database 2000 (LHID2000). We selected patients hospitalized with pelvic fractures between 1997 and 2013 for study. Patients who had index data before 2000 or after 2010 (n = 963), who died before the index date (n = 64), who were aged <18 years (n = 94), or who had a pelvic injury (n = 31) were excluded. In total, the study cohort comprised 1623 adult patients; 115 had UTIs, and 1508 patients without UTIs were used as a comparison cohort. Multivariate analysis with a multiple Cox regression model and Kaplan–Meier survival analysis were performed to analyze the data. Our results showed that the 1-year mortality rate (adjusted hazard ratio [HR]: 2.32; 95% CI: 1.25–4.29) and readmission rate (adjusted HR: 1.72; 95% CI: 1.26–3.34) of the UTI group were significantly higher than those of the non-UTI group. Moreover, the Kaplan–Meier curve for the 1-year follow-up indicated that the UTI group had a higher cumulative risk of both mortality and hospital readmission compared with the non-UTI group. In conclusion, among patients with pelvic fracture, patients with UTI were associated with increased risks of mortality and readmission. Physicians must pay more attention to such patients to prevent UTIs among patients with pelvic fractures during hospitalization and conduct a follow-up after discharge within at least 1 year.

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Pelvic Fractures and Associated Genitourinary and Vascular Injuries: A Multisystem Review of Pelvic Trauma

Cited by 23 publications

References 56 publications

Large traumatic vulvar hematoma managed with a simple incision: A case report

Large traumatic vulvar hematoma managed with a simple incision: A case report

Comparison of percutaneous cross screw fixation versus open reduction and internal fixation for pelvic Day type II crescent fracture-dislocation: case-control study

Risk of Mortality and Readmission among Patients with Pelvic Fracture and Urinary Tract Infection: A Population-Based Cohort Study

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