J Acute Care Surg.  2021 Mar;11(1):14-21. 10.17479/jacs.2021.1.14.

Relevant Clinical Findings of Patients with Extraperitoneal Bladder Injury Associated with Pelvic Fracture Who Underwent Operative Management: A 6-Year Retrospective Study

Affiliations
  • 1Department of Trauma Surgery and Surgical Critical Care, Pusan National University Hospital, Busan, Korea
  • 2Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
  • 3Pusan National University School of Medicine, Yangsan, Korea
  • 4Department of Radiology, Catholic University of Korea Eunpyeong St. Mary’s Hospital, Seoul, Korea
  • 5Department of Orthopedic Surgery, Pusan National University Hospital, Busan, Korea
  • 6Department of Trauma Surgery, Seoul National University Hospital, Seoul, Korea
  • 7Department of Emergency Medicine, Pusan National University Hospital, Busan, Korea

Abstract

Purpose
Management options for extraperitoneal bladder injury (EBI) associated with pelvic fracture are variable. Predictive factors of operative management (OM) in patients with EBI associated pelvic fracture have not been previously addressed. This study assessed the current epidemiology of blunt traumatic urinary bladder injury and evaluated relevant clinical findings of patients with EBI associated with pelvic fracture who received OM.

Methods
Patients with urinary bladder injury with or without pelvic fracture from blunt trauma from January 1, 2014 to December 31, 2019 were identified from the institute trauma registry (n = 12,891). Demographics, mechanism of injury, type of urinary bladder injury, pelvic fracture configuration, and management options were analysed in the study population (n = 9,894).

Results
Of the 1,400 patients who had pelvic and/or acetabular fracture, 32 (2.3%) had urinary bladder injury. Of the 8,494 patients without pelvic and/or acetabular fracture, 12 (0.1%) had nonpelvic fracture urinary bladder injury. The total incidence of urinary bladder injuries in the study population was 0.4% (44/9,894). Patients with EBI associated with pelvic fracture who underwent OM, had a higher frequency of high-grade pelvic injury (100% vs 0%, p = 0.015), concomitant pelvic surgery (75.0% vs 0%, p = 0.001), and non-lateral compression type pelvic fracture (62.5% vs 10.0%, p = 0.043) compared with patients who underwent non-operative management of EBI.

Conclusions
These data suggest that OM may be considered especially in patients with EBI associated with pelvic fracture with high grade pelvic injury, concomitant pelvic surgery, and nonlateral compression type pelvic fracture.

Keyword

urinary bladder; epidemiology; pelvic bone; multiple trauma; operative procedure
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