Purpose Injury to the urethra is an uncommon complication of pelvic fracture in male blunt trauma victims. We evaluated whether there was an association between location and displacement of anterior pelvic fractures and presence of urethral injury.
Methods and Materials We completed a retrospective, nested case-control study of 119 male patients, a subset of a previously reported cohort from a large level 1 trauma center between January 1, 1997 and July 15, 2003. We performed detailed measurements of the location, displacement, and direction of force of each anterior pelvic fracture from CT scans and pelvic radiographs. Multiple logistic regression was used to determine the presence and strength of any association between specific anterior pelvic fracture locations and urethral injury after controlling for age, mechanism of injury, overall injury severity, and direction of force. The study design and implementation were approved by the institutional review board with a waiver of informed consent.
Results Urethral injury was present in 25 patients, and all had anterior pelvic fracture (inclusive of pubic symphysis diastasis). There were no urethral injuries in patients with fractures isolated to the acetabulum. Pelvic fractures that were independently associated with urethral injury in the multiple regression model included displaced fractures of the inferomedial pubic bone, OR = 6.4 (95% CI 1.6 to 24.9), and symphysis pubis diastasis, OR = 11.8 (95% CI 4.0 to 34.5). Each millimeter of diastasis of the symphysis pubis or displacement of an inferomedial pubic bone fracture was associated with an approximately 10% increased risk for urethral injury.
Conclusions The location and extent of displacement of anterior pelvic fractures in males predict risk of urethral injury and may be valuable in determining when evaluation of the urethra is appropriate.
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