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



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.


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.


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).


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.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2


  1. 1.

    Grotz MRW et al (2005) Open pelvic fractures: epidemiology, current concepts of management and outcome. Injury 36:1–13

    CAS  Article  Google Scholar 

  2. 2.

    Demetriades D et al (2002) Pelvic fractures: epidemiology and predictors of associated abdominal injuries and outcomes. J Am Coll Surg 195:1–10

    Article  Google 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)

    CAS  Article  Google Scholar 

  4. 4.

    Bjurlin MA et al (2009) Genitourinary injuries in pelvic fracture morbidity and mortality using the National Trauma Data Bank. J Trauma 67:1033–1039

    Article  Google Scholar 

  5. 5.

    Brandes S, Borrelli J (2001) Pelvic fracture and associated urologic injuries. World J Surg 25:1578–1587

    CAS  Article  Google Scholar 

  6. 6.

    Kahn CA, Gotschall CS (2015) The economic and societal impact of motor vehicle crashes, 2010 (Revised). Ann Emerg Med 66:194–196

    Article  Google 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 177:571–575

    Article  Google 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 16:449–452

    Google 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 52:205–209

    Article  Google Scholar 

  10. 10.

    Matlock KA et al (2013) Blunt traumatic bladder rupture: a 10-year perspective. Am Surgeon 79:589–593

    PubMed  Google 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 100:567–573

    Article  Google Scholar 

  12. 12.

    Koraitim MM (1999) Pelvic fracture urethral injuries: the unresolved controversy. J Urol 161:1433–1441

    CAS  Article  Google Scholar 

  13. 13.

    Lunsjo K, Abu-Zidan FM (2006) Does colostomy prevent infection in open blunt pelvic fractures? A systematic review. J Trauma 60:1145–1148

    Article  Google Scholar 

  14. 14.

    Melton LJ et al (1981) Epidemiologic features of pelvic fractures. Clin Orthop Relat Res 155:43–47

    Google 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 74:901–906

    Article  Google Scholar 

  16. 16.

    Aprato A et al (2016) Direct and indirect costs of surgically treated pelvic fractures. Arch Orthop Trauma Surg 136:325–330

    Article  Google Scholar 

  17. 17.

    Velmahos GC et al (2000) Operative management of civilian rectal gunshot wounds: simpler is better. World J Surg 24:114–118

    CAS  Article  Google Scholar 

  18. 18.

    Franko ER, Ivatury RR, Schwalb DM (1993) Combined penetrating rectal and genitourinary injuries: a challenge in management. J Trauma 34:347–353

    CAS  Article  Google Scholar 

  19. 19.

    Pereira BM et al (2014) Penetrating bladder trauma: a high risk factor for associated rectal injury. Adv Urol 2014:386280

    CAS  Article  Google Scholar 

  20. 20.

    Crispen PL et al (2007) Immediate postoperative complications of combined penetrating rectal and bladder injuries. J Trauma 62:325–329

    Article  Google Scholar 

  21. 21.

    Chu CH et al (2016) Trends in the management of pelvic fractures, 2008–2010. J Surg Res 202:335–340

    Article  Google 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 205:365–370

    Article  Google 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 192:1131–1136

    Article  Google Scholar 

Download references


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.

Author information




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.

Corresponding author

Correspondence to Marc A. Bjurlin.

Ethics declarations

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.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 11 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Velazquez, N., Fantus, R.J., Fantus, R.J. et al. Blunt trauma pelvic fracture-associated genitourinary and concomitant lower gastrointestinal injury: incidence, morbidity, and mortality. World J Urol 38, 231–238 (2020).

Download citation


  • Trauma
  • GI injury
  • GU injury