Advertisement

Blunt trauma pelvic fracture-associated genitourinary and concomitant lower gastrointestinal injury: incidence, morbidity, and mortality

  • Nermarie Velazquez
  • Richard Jacob Fantus
  • Richard Joseph Fantus
  • Samuel Kingsley
  • Marc A. BjurlinEmail author
Original Article
  • 33 Downloads

Abstract

Purpose

Limited data exist on the characteristics, risk factors, and management of blunt trauma pelvic fractures causing genitourinary (GU) and lower gastrointestinal (GI) injury. We sought to determine these parameters and elucidate independent risk factors.

Methods

The National Trauma Data Bank for years 2010–2014 was queried for pelvic fractures by ICD-9-CM codes. Exclusion criteria included age ≤ 17 years, penetrating injury, or incomplete records. Patients were divided into three cohorts: pelvic fracture, pelvic fracture with GU injury, and pelvic fracture with GU and GI injury. Between-group comparisons were made using stratified analysis. Multivariable logistic regression was used to determine independent risk factors for concomitant GI injury.

Results

In total, 180,931 pelvic fractures were found, 3.3% had GU, and 0.15% had GU and GI injury. Most common mechanism was vehicular collision. Injury severity score, pelvic AIS, and mortality were higher with combined injury (p < 0.001), leading to longer hospital and ICU stays and ventilator days (p < 0.001) with more frequent discharges to acute rehabilitation (p < 0.01). Surgical management of concomitant injuries involved both urinary (62%) and rectal repairs (81%) or diversions (29% and 46%, respectively). Male gender (OR = 2.42), disruption of the pelvic circle (OR = 6.04), pubis fracture (OR = 2.07), innominate fracture (OR = 1.84), and SBP < 90 mmgh (OR = 1.59) were the strongest independent predictors of combined injury (p < 0.01).

Conclusion

Pelvic fractures with lower GU and GI injury represent < 1% of pelvic fractures. They are associated with more severe injuries and increased hospital resource utilization. Strongest independent predictors are disruption of the pelvic circle, male gender, innominate fracture, and SBP < 90mm Hg.

Keywords

Trauma GI injury GU injury 

Notes

Acknowledgements

Committee on Trauma, American College of Surgeons, NTDB version, Chicago, IL, 2015. The content reproduced from the NTDB remains the full and exclusive copyrighter property of the American College of Surgeons. The American College of Surgeons is not responsible for any claims arising from works based on the original data, text, tables, or figures.

Authors’ contribution

NV and RJaF developed the project and wrote the manuscript; RJoF helped in project development, data collection and management; SK contributed to data collection and management and data analysis; MAB developed the project and wrote and edited the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This is a retrospective study, conducted on already available data. It did not necessitate IRB approval at our institution. Separate informed consent was not necessary as data are obtained from a national repository in a de-identified manner. The authors attest that this article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

345_2019_2725_MOESM1_ESM.docx (12 kb)
Supplementary material 1 (DOCX 11 kb)

References

  1. 1.
    Grotz MRW et al (2005) Open pelvic fractures: epidemiology, current concepts of management and outcome. Injury 36:1–13CrossRefPubMedGoogle Scholar
  2. 2.
    Demetriades D et al (2002) Pelvic fractures: epidemiology and predictors of associated abdominal injuries and outcomes. J Am Coll Surg 195:1–10CrossRefPubMedGoogle Scholar
  3. 3.
    Poole GV et al (1991) Pelvic fracture from major blunt trauma. Outcome is determined by associated injuries. Ann Surg 213:532–538 (discussion 538–539) CrossRefPubMedGoogle Scholar
  4. 4.
    Bjurlin MA et al (2009) Genitourinary injuries in pelvic fracture morbidity and mortality using the National Trauma Data Bank. J Trauma 67:1033–1039CrossRefPubMedGoogle Scholar
  5. 5.
    Brandes S, Borrelli J (2001) Pelvic fracture and associated urologic injuries. World J Surg 25:1578–1587CrossRefPubMedGoogle Scholar
  6. 6.
    Kahn CA, Gotschall CS (2015) The economic and societal impact of motor vehicle crashes, 2010 (Revised). Ann Emerg Med 66:194–196CrossRefGoogle Scholar
  7. 7.
    Basta AM, Blackmore CC, Wessells H (2007) Predicting urethral injury from pelvic fracture patterns in male patients with blunt trauma. J Urol 177:571–575CrossRefPubMedGoogle Scholar
  8. 8.
    Hammad F et al (2010) Genitourinary injuries following road traffic collisions: a population-based study from the Middle East Karayolu trafik kazalarına bağlı genitoüriner yaralanmalar: Orta Doğu’dan nüfusa dayalı bir çalışma. Turk J Trauma Emerg Surg 16:449–452Google Scholar
  9. 9.
    Aihara R et al (2002) Fracture locations influence the likelihood of rectal and lower urinary tract injuries in patients sustaining pelvic fractures. J Trauma Injury Infect Crit Care 52:205–209CrossRefGoogle Scholar
  10. 10.
    Matlock KA et al (2013) Blunt traumatic bladder rupture: a 10-year perspective. Am Surgeon 79:589–593PubMedGoogle Scholar
  11. 11.
    Andrich DE, Day AC, Mundy AR (2007) Proposed mechanisms of lower urinary tract injury in fractures of the pelvic ring. BJU Int 100:567–573CrossRefPubMedGoogle Scholar
  12. 12.
    Koraitim MM (1999) Pelvic fracture urethral injuries: the unresolved controversy. J Urol 161:1433–1441CrossRefPubMedGoogle Scholar
  13. 13.
    Lunsjo K, Abu-Zidan FM (2006) Does colostomy prevent infection in open blunt pelvic fractures? A systematic review. J Trauma 60:1145–1148CrossRefPubMedGoogle Scholar
  14. 14.
    Melton LJ et al (1981) Epidemiologic features of pelvic fractures. Clin Orthop Relat Res 155:43–47Google Scholar
  15. 15.
    Cannada LK et al (2013) The Jones-Powell Classification of open pelvic fractures: a multicenter study evaluating mortality rates. J Trauma Acute Care Surg 74:901–906CrossRefPubMedGoogle Scholar
  16. 16.
    Aprato A et al (2016) Direct and indirect costs of surgically treated pelvic fractures. Arch Orthop Trauma Surg 136:325–330CrossRefPubMedGoogle Scholar
  17. 17.
    Velmahos GC et al (2000) Operative management of civilian rectal gunshot wounds: simpler is better. World J Surg 24:114–118CrossRefPubMedGoogle Scholar
  18. 18.
    Franko ER, Ivatury RR, Schwalb DM (1993) Combined penetrating rectal and genitourinary injuries: a challenge in management. J Trauma 34:347–353CrossRefPubMedGoogle Scholar
  19. 19.
    Pereira BM et al (2014) Penetrating bladder trauma: a high risk factor for associated rectal injury. Adv Urol 2014:386280CrossRefPubMedGoogle Scholar
  20. 20.
    Crispen PL et al (2007) Immediate postoperative complications of combined penetrating rectal and bladder injuries. J Trauma 62:325–329CrossRefPubMedGoogle Scholar
  21. 21.
    Chu CH et al (2016) Trends in the management of pelvic fractures, 2008–2010. J Surg Res 202:335–340CrossRefPubMedGoogle Scholar
  22. 22.
    Bolorunduro OB et al (2013) Disparities in trauma care: are fewer diagnostic tests conducted for uninsured patients with pelvic fracture? Am J Surg 205:365–370CrossRefPubMedGoogle Scholar
  23. 23.
    Bjurlin MA et al (2014) The impact of seat belts and airbags on high grade renal injuries and nephrectomy rate in motor vehicle collisions. J Urol 192:1131–1136CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Nermarie Velazquez
    • 1
  • Richard Jacob Fantus
    • 2
  • Richard Joseph Fantus
    • 3
  • Samuel Kingsley
    • 3
  • Marc A. Bjurlin
    • 4
    Email author
  1. 1.Department of UrologyNYU Langone HealthNew YorkUSA
  2. 2.Section of UrologyThe University of Chicago Medical CenterChicagoUSA
  3. 3.Department of Surgery, Section of Trauma, and Surgical Critical CareAdvocate Illinois Masonic Medical CenterChicagoUSA
  4. 4.Department of Urology and Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillUSA

Personalised recommendations