Pelvic Bone Fracture with Bladder Rupture

Sang Hong Lee; Kung Chul Song; Sang Ha Park; Chi Hyoung Park; Sueng-Hwan Jo; Dong Hoon Lim

doi:10.4055/jkoa.2013.48.3.222

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Lee, Song, Park, Park, Jo, and Lim: Pelvic Bone Fracture with Bladder Rupture

Original Article

Journal of the Korean Orthopaedic Association 2013; 48(3): 222-230.

Published online: 24 June 2013

DOI: https://doi.org/10.4055/jkoa.2013.48.3.222

Pelvic Bone Fracture with Bladder Rupture

Sang Hong Lee, M.D., Kung Chul Song, M.D., Sang Ha Park, M.D., Chi Hyoung Park, M.D., Sueng-Hwan Jo, M.D., Dong Hoon Lim, M.D.^*

Department of Orthopaedic Surgery, School of Medicine, Chosun University, Gwangju, Korea.

^*Department of Urology, School of Medicine, Chosun University, Gwangju, Korea.

Correspondence to: Kung Chul Song, M.D. Department of Orthopaedic Surgery, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 501-717, Korea. TEL: +82-62-220-3147, FAX: +82-62-226-3379, kkamtol@hanmail.net

Received 28 November 2012 Revised 15 February 2013 Accepted 2 April 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to evaluate the injury mechanism of pelvic bone fracture and injury type and treatment of bladder rupture associated with pelvic bone fracture.

Materials and Methods

From September 2002 to February 2011, we treated pelvic bone fracture with bladder rupture in 56 cases with minimal follow up of one year. Each of the 56 cases was classified into groups depending on the mechanism of pelvic fracture (Young classification) and the aspect of bladder rupture (intraperitoneal rupture, extraperitoneal rupture, combined rupture) after which the relationship between the two aspects was analyzed retrospectively.

Results

There were a total of 56 cases where bladder ruptures occurred in association with pelvic bone fractures; 34 patients were men and 22 patients were women. The average age was 58.2 years (range: 19-84). Traffic accidents were the main cause of pelvic bone fractures with bladder ruptures in 41 cases. The main injury mechanism was lateral compression, and pubic ramus fractures occurred in 38 cases (67.9%). Regarding the classifications of bladder ruptures, there were 17 cases of intraperitoneal rupture, 37 cases of extraperitoneal rupture, and two cases of combined rupture. Operations were performed on all cases of intraperitoneal and combined rupture and on six cases of extraperitoneal rupture.

Conclusion

Lateral compression was the most common injury of bladder rupture in pelvic bone fracture. Bladder ruptures occurred even in cases where the displacement of pelvic bones was not severe and also in cases of low energy injury.

Keywords: pelvic bone fracture, traumatic bladder rupture

Figures and Tables

Figure 1

Rupture of the urinary bladder. A: intraperitoneal cavity, B: extraperitoneal cavity, (1) pubic ramus, (2) bladder, (3) urethra.

Figure 2

A 59-year-old female patient was injured after falling down, with occurrence of right pubic inferior ramus fracture, left sacral alar fracture, and sacroiliac joint separation (not classified by Young classification). (A) Pelvic inlet image shows bony fragments of the right pubic inferior ramus fracture (black arrow). (B) Pelvis computed tomography axial view shows bladder rupture by bony fragments of the pubic ramus (black arrow). (C) Cystogram shows extraperitoneal contrast material extravasation extending around the bladder (black arrows). This cystogram shows an extraperitoneal bladder rupture. (D) Clinical picture shows intraoperative finding that bladder ruptured by bony fragments of the pubic ramus. (E) Excision of bony fragments. (F) Cystogram shows a well-repaired bladder with no contrast leakage at two weeks after the operation.

Figure 3

Algorithm for diagnosis and management of bladder and urethral injuries associated with pelvic fractures. RUG, retrograde urethrogram.

Figure 4

A 58-year-old male patient was injured after being pressed by a tree, with occurrence of right iliac wing comminuted fracture, both pubic superior and inferior ramus fracture, and right sacral alar fracture (lateral compression grade III injury of Young classification). (A) Cystogram shows extraperitoneal contrast material extravasation extending around the bladder (black arrows). This cystogram shows an extraperitoneal bladder rupture. (B) Retrograde urethrogram shows contrast material extravasation from the posterior urethra (black arrow). This retrograde urethrogram shows injury of the posterior urethra. (C) Cystogram shows a well-healing bladder, with no leakage of contrast material at two weeks after foley catheter insertion. (D) Retrograde urethrogram shows a well-healing posterior urethra, with no leakage of contrast material at two weeks after foley catheter insertion. (E) Retrograde urethrogram shows a well-healing posterior urethra without stricture at two months after Foley catheter insertion.

Table 1

Treatment of Bladder Rupture Type

Values are presented as number (%).

Table 2

Treatment of Pelvic Bone Fracture

Values are presented as number (%).

Notes

This work was supported by a grant from the Clinical Medicine Research Institute of the Chosun University Hospital (2007).

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