• Journal of Trauma and Injury
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• 제35권1호
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• pp.51-55
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• 2022

Pelvic ring injuries have high mortality and morbidity rates, and they are difficult to treat because accompanying injuries to the pelvic organs, genitourinary organs, and neurovascular tissues are common. Genitourinary injuries are common comorbid injuries that have been reported to occur in 5% to 6% of all pelvic ring injuries. However, these injuries usually occur simultaneously with the pelvic ring injury, whereas relatively little research has dealt with genitourinary injuries that occur after treatment of a pelvic ring injury. To the best of our knowledge, only three cases of delayed bladder perforation due to screw loosening after symphyseal plate fixation in anterior pelvic ring injury have been reported worldwide, and no such cases have yet been reported in Korea. Since the authors experienced this very rare complication after pelvic ring surgery, we report this case along with a literature review.

• Journal of Trauma and Injury
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• 제34권2호
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• pp.98-104
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• 2021

Purpose: Severe pelvic fractures are associated with genitourinary injuries, but the relationship between pelvic trauma and concomitant urethral injuries has yet to be elucidated. This study evaluated the incidence, mechanism, site, and extent of urethral injuries in male patients with pelvic fractures. Methods: A retrospective cohort study was performed involving patients with urethral injuries accompanying pelvic fractures who visited Pusan National University Hospital from January 1, 2014 to December 31, 2019. Demographics, mechanisms of injury, clinical features of the urethral injuries, concomitant bladder injuries, methods of management, and the configuration of the pelvic fractures were analyzed. Results: The final study population included 24 patients. The overall incidence of urethral injury with pelvic fracture was 2.6%, with the most common mechanism of urethral injury being traffic accidents (62.5%). Complete urethral disruption (16/24, 66.7%) was more common than partial urethral injuries (8/24, 33.3%), and unstable pelvic fractures were the most common type of pelvic fracture observed (70.8%). There was no definitive relationship between the extent of urethral injury and pelvic ring stability. Conclusions: The present study provides a 6-year retrospective review characterizing the incidence, mechanism, and clinical features of urethral injury-associated pelvic fractures. This study suggests that the possibility of urethral injury must be considered, especially in unstable pelvic fracture patients, and that treatment should be chosen based on the clinical findings.

• Journal of Trauma and Injury
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• 제36권3호
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• pp.298-303
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• 2023

Unstable pelvic ring injuries are potentially life-threatening and associated with high mortality and complication rates in polytrauma patients. The most common cause of death in patients with pelvic ring injuries is massive bleeding. With resuscitation, external fixation can be performed as a temporary stabilization procedure for hemostasis in unstable pelvic fractures. Internal fixation following temporary external fixation of the pelvic ring yields superior and more reliable stabilization. However, a time-consuming extended approach to open reduction and internal fixation of the pelvic ring is frequently precluded by an unacceptable physiologic condition and/or concomitant injuries in patients with multiple injuries. Conservative treatment may lead to pelvic ring deformity, which is associated with various functional disabilities such as limb length discrepancy, gait disturbance, and sitting intolerance. Therefore, if the patient is not expected to be suitable for additional surgery due to a poor expected physiologic condition, definitive external fixation in combination with various percutaneous screw fixations to restore the pelvic ring should be considered in the acute phase. Herein, we report a case of unstable pelvic ring injury successfully treated with definitive external fixation and percutaneous screw fixation in the acute phase in a severely injured polytrauma patient.

• Journal of Trauma and Injury
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• 제20권2호
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• pp.90-95
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• 2007

Purpose: This research was conducted to study whether the specific location of pelvic-bone fractures could increase the risk for injury to the urinary bladder, urethra, or lower gastrointestinal tract. Methods: We retrospectively reviewed the data of 234 patients with pelvic-bone fractures who visited the emergency department of Kyungpook National University Hospital from January 2004 to December 2006. The location of the pelvic-bone fracture was divided into 8 parts. The association of fracture location with injury to the urinary bladder, urethra, or lower gastrointestinal tract was analyzed with Fisher' s-exact test and multiple logistic regression. Results: Nineteen(19) patients had urinary bladder injury, 8 had urethral injury, and 9 had lower gastrointestinal tract injury. The following fracture locations were found to be significant; urinary bladder: sacroiliac (SI) joint (p<0.001), symphysis pubis (p=0.011), and sacrum (p=0.005); urethra: SI joint (p=0.020); lower gastrointestinal tract: symphysis pubis (p=0.028). After the multiple logistic regression analysis, the primary and the independent predictors for each of the injuries were as follows; urinary bladder: sacroiliac joint (p=0.000, odds ratio [OR]=10.469); lower gastrointestinal tract: symphysis pubis (p=0.037, OR=7.009). Conclusion: Consideration of further workup for injuries to the lower gastrointestinal and urinary tract is needed for some locations of pelvic-bone fractures because certain pelvic-bone fracture locations, especially the sacroiliac joint and the symphysis pubis, are associated with increased risk for injury to the lower gastrointestinal and urinary tracts.

• Journal of Trauma and Injury
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• 제29권4호
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• pp.201-203
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• 2016

Rectal injury is seen in 1-2% of all pelvic fractures, and lower urinary tract injury occurs in up to 7%. These injuries are rare, but if missed, can lead to a severe septic response. Rectal injury may be suspected by the presence of gross blood on digital rectal examination. However, this classic sign is not always present on physical examination. If an Antero-Posterior Compression type pelvic fracture is seen, we should consider the possibility of rectal and lower urinary tract injury. It is important to define the anatomic location of the rectal injury as it relates to the peritoneal reflection. Trauma to the intraperitoneal rectum should be managed as a colonic injury. Extraperitoneal rectal injury should be managed with fecal diversion regardless of primary repair. We present the case of a 46-year-old man who was referred to our hospital following a major trauma to the pelvis in a pedestrian accident.

• Journal of Trauma and Injury
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• 제20권1호
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• pp.26-32
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• 2007

Purpose: Hemorrhagic shock is the leading cause of death in patients with pelvic bone fractures. The majority of blood loss is due to injured pelvic arteries and retroperitoneal veins and to bleeding from the fracture site itself. Pelvic angiography and embolization of injured vessels is an effective way to control continuous bleeding. However, identifying the bleeding focus in hemodynamically unstable patients before diagnostic intervention is difficult. The purpose of this study was to determine the correlation between fracture patterns in hemodynamically unstable patients with pelvic fractures and later pelvic angiography findings. Methods: We performed a retrospective study of 21 hemodynamically unstable patients with pelvic fractures admitted to our emergency department between April 2001 to April 2006. All 21 patients underwent pelvic angiography. Pelvic fractures were assessed according to the Tile's classification and the degree of injury was assessed using the Injury Severity Score (ISS) and Revised Trauma Score (RTS). The hemodynamic status of the patients was defined using vital signs, base excess, and blood lactate. Fracture patterns were compared with hemodynamic status and angiography findings. Results: In the 5year study period, 21 hemodynamically unstable pelvic bone fracture patients were admitted; ten were men (47.6%), and 11 were women (52.4%). The mean age was 41.1 years (range: ${\pm}20.1$). Of the 21 embolization was performed in 6 patient (28.6%): 1 patient of the 5 unstable pelvic bone fracture patients (20%), and 5 patients of 16 the stable pelvic bone fracture patients (31.3%). There were no significant differences between the RTS (p=0.587) and embolization rate (p=0.774) for either the stable patients or the unstable patients. Patients with arterial injury on angiography had a lower RTS compared with patients without arterial injury but there was no significant difference in ISS between the two groups. The angiographic injured sites were five internal femoral arteries and one external femoral artery. Conclusion: The findings in this study suggest that the pelvic fracture pattern in hemodynamically unstable patients with pelvic fractures does not correlate with pelvic angiography findings.

• Journal of Trauma and Injury
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• 제28권3호
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• pp.144-148
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• 2015

Purpose: Immediate identification of vascular injury requiring embolization in patients with pelvic bone fracture isn't an easy task. There have been many trials finding indicators of embolization for patients with pelvic bone fracture. Although Young and Burgess classification is useful in decision making of treatment, it is reported to have little value as indicator of embolization in major trauma patients. The aim of this study is to find out Young and burgess classification on predicting vessel injury by analzyng pelvic radiograph taken from major trauma patients with pelvic bone fracture. Methods: Among major trauma patients with injury severity scores (ISS) higher than 15 who visited our emergency room from January 2011 to June 2014, 200 patients were found with pelvic bone fracture in trauma series and thus pelvic CT angiography was taken. Setting aside patients with exclusion criteria, 153 patients were enrolled in this study for analysis of Young and Burgess classification. Results: The most common mechanism of injury was lateral compression in both groups. There was no statistical significant difference in Young and Burgess classification (p=0.397). The obturator artery was the most commonly injured artery in both groups. Six patients had more than one site of bleeding. Conclusion: Prediction of transcatheter angiographic embolization using Young and Burgess classification in severe trauma patients is difficult and requires additional studies.

• Journal of Trauma and Injury
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• 제22권2호
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• pp.254-259
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• 2009

Purpose: Pelvic trauma is a serious skeletal injury with high mortality. Especially in cases of severe injury trauma, treatment outcomes depend on early diagnosis and intervention. We expect trauma surgeon to play an important role in the management of severe multiple trauma patients. Methods: A retrospective study was performed on pelvic trauma patients with hemodynamic instability between March 2005 and September 2009. We divided the time period into period I (March 2005~Feburary 2009) and period II (March 2009~September 2009). The trauma surgeon and team started to work from period II. Data were collected regarding demographic characteristics, mechanism of injury, type of pelvic fracture, ISS(injury severity score), treatment modality, transfusion requirement, time to definitive treatment, and mortality. Results: During period I, among 7 hemodynamically unstable patients, 4(57.1%) patients died. However during Period II, only one of 6(16.6%) patients died. The demographic data and injury scores showed no differences between the two time periods, but the time to definitive treatment was very short with trauma team intervention(14.4 hrs vs. 3.9 hrs). Also, the amount of transfusion was less(41.1 U vs. 13.9 U). With arterial embolization, early pelvic external fixation led to less transfusion and made patients more stable. Conclusion: This study demonstrated the importance of the trauma surgeon and the trauma team in cases of hemodynamically unstable pelvic trauma. Even with the same facility and resources, an active trauma team approach can increase the survival of severely injured multiple trauma patients.

• Journal of Trauma and Injury
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• 제36권4호
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• pp.451-453
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• 2023

We introduce a convenient method of urethrography before catheterization for patients with pelvic trauma that can be used in a resuscitation area. A 10-mL syringe without a needle was used. X-ray contrast medium (Iohexol, 300 mg I/mL) was administered through the urethral orifice using a 10-mL syringe without needle and a simple pelvic anteroposterior film was taken (70 kilovolt [peak], 50 mAs). A 36-year-old soldier with a saddle injury from a gun barrel was taken to a trauma center. He had a pelvic fracture and complained of hematuria. Bedside urethrography above described was performed. The anterior urethra showed nonspecific findings, but dye leaked from the posterior urethra. Bedside Foley catheter insertion was attempted, but the catheter could not be advanced past the membranous urethra. Thereafter, suprapubic catheterization was performed. On the day of the injury, iliac artery embolization was carried out. The dislocated sacroiliac joint was also treated using open reduction and internal fixation. On hospital day 7, guidewire Foley insertion was performed. This bedside urethrography technique is simple and useful for pelvic fractures in which urethral injury is suspected.

• 대한정형외과학회지
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• 제55권6호
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• pp.540-544
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• 2020

불안정성 골반환 손상은 고에너지 외상으로 발생하게 되는데 종종 비뇨기과적인 손상을 동반하기도 한다. 비뇨기과적 손상으로는 방광, 요관, 요도 손상이 흔하다. 고환 탈구는 골반환 손상에 동반될 수 있으나 매우 드문 것으로 보고되고 있다. 이 경우 고환의 탈구로 인한 통증을 환자가 호소하여도 골반환 손상에 의한 통증으로 간과되기가 쉽다. 고환 탈구가 조기에 진단되지 않아 치료가 지연되면 고환 괴사 등과 같은 합병증으로 이어질 수 있어 주의를 요한다. 본 저자들은 골반환 손상에 동반된 고환 탈구환자를 경험하여 이에 대한 증례보고를 하고자 한다