Other injuries

Genitourinary injuries (5-10%)

• Urethral injury (anterior: penile/bulbar usually caused by straddle injury, posterior: membranous/prostatic usually caused by crushing force to the pelvis in RTC) 
• Bladder rupture (intraperitoneal/ extraperitoneal)

The presence of blood at the urethral meatus, ecchymosis or hematoma of the scrotum and perineum are strongly suggestive of urethral injury, although these signs may be absent immediately after injury. Palpation of the prostate gland is not a reliable sign of urethral injury. Gross haematuria or blood stained urine is also an indication of trauma to the genitourinary tract (including the kidney, ureters, and bladder). The absence of haematuria does not exclude an injury to the genitourinary tract. Presence of any of the above findings MANDATES a catheter retrograde cystogram/ urethrogram to investigate for GU injuries. This can be done via urethral/suprapubic catheter. Consult urology specialist for advice prior to inserting catheter if urethral injury is suspected. Do not place a urinary catheter in a patient with a perineal hematoma or blood at the urethral meatus before a definitive assessment for urethral injury.

Useful guide from BOAST on The Management of Urological Trauma Associated with Pelvic Fractures here.

Gastrointestinal injuries (5%)

• May need urgent bowel diversion or a de-functioning stoma and washout
• Urgent senior general surgical input is required
• Any colostomy should be sited in an upper abdominal quadrant remote from potential definitive pelvic surgical fixation approaches
• Risk of death from secondary sepsis and bowel content contamination

In patients who have sustained blunt trauma, the goals of the rectal examination are to assess sphincter tone and rectal mucosal integrity and to identify any palpable fractures of the pelvis.  In patients with penetrating wounds, the rectal examination is used to assess sphincter tone and to look for gross blood, which may indicate a bowel perforation.

The gluteal region extends from the iliac crests to the gluteal folds. Penetrating injuries to this area are associated with up to a 50% incidence of significant intra-abdominal injuries, including rectal injuries below the peritoneal reflection. These wounds mandate an evaluation for such injuries.

Vaginal injuries (<5%)

Bony fragments from pelvic fracture or penetrating wounds can lacerate the vagina. Perform a vaginal exam when injury is suspected, such as in the presence of complex perineal laceration, pelvic fracture, or transpelvic gunshot wound. In unresponsive menstruating women, examine the vagina for the presence of tampons left in place, they can cause delayed sepsis.

Learning bite

Pelvic fracture can be associated with complex injuries requiring multispecialty input.