GU & Pelvic Trauma Basics
- Pelvic fracture, direct blow, penetrating injury - bladder rupture in 5-10% of pelvic fractures (more fractures = higher risk of injury)
- Intraperitoneal - dome is the weakest part (surgical repair)
- Extraperitoneal - manage with foley
Evaluation of the GU Tract
- Look for extravasation & look for contrast in bladder - if no contrast in the bladder = complete disruption of urethra - this requires surgery; some partial injuries can be managed with Foley catheter.
Upper Tract Injury
- flank bank or abdominal pain with gross hematuria or microscopic hematuria with shock
- 85% of renal injuries are secondary to blunt trauma;
- any penetrating trauma near this area requires evaluation of kidneys
- management depends on grade of injury
- Ureteral injuries - easy to miss; tend to present late
Pelvic Ring Fractures
- pelvis is strong - takes a lot of force to break it;
Assess for injuries:
a. Proximate - urethra, bladder, vagina, sciatic nerve
b. Distant - brain, chest, aorta, intra-abdominal
Who to image- physical findings suggestive of injury, shock
1. Lateral compression - horizontal anterior ring fracture- look for sacral fracture
2. AP - open book fracture - high risk of bleeding out - "mac daddy of pelvic fracture"
3. Vertical Sheer - high risk of vascular injury - if no femur fracture put in traction
4. Posterior ring disruption - increased mortality
Unstable patients with pelvic fracture
- angio vs OR: if grossly positive FAST, OR first. If not, angio first.