Urethral injury secondary to advanced fragility fracture of the pelvis: A case report

Abstract text (incl. references and figure legends)

Case history: 83-year-old woman with no trauma history complaining acute pain in right groin was admitted to emergency room.

Clinical findings: She showed swelling in her groin and urinary retention. Vital signs at admission were stable.

Investigation/Results: Computed tomography (CT) showed bilateral iliac fractures with insufficient callus and right pubic ramus fracture with osteolytic lesion, which were considered advanced fragility fracture of the pelvis (FFP). It also showed a balloon of Foley catheter besides fractured pubic ramus that deviated from urethra. Enhanced CT showed accumulation of fluid with surrounding inflammation from right pubis to adductor muscles.

Diagnosis: Urethral injury and groin abscess secondary to advanced FFP (Rommens classification type IVa)

Therapy and Progressions: Cystostomy, puncture drainage for the groin abscess, and antibiotic administrations were performed to control the leakage of urine and the infection. At 3 weeks after admission, as the leakage and the infection had been improved, we performed internal fixations for bilateral iliac fractures to obtain enough stability for mobilization and avoiding further injury of urethra. Although she needs permanent cystostomy tube, she is able to stand alone without pain at 10 weeks after surgery.

Comments: Urethral injury is common in pelvic trauma and usually occurs at the time of high energy injury. In the presented case, chronic instability of the pelvic ring, caused by progressive FFP, had resulted in the complete rupture of urethra. Bladder rupture is more common among urinary tract complications due to FFPs. This is the first report of urethral rupture secondary to advanced FFPs.

References:

N. V. Johnsen, et al. Epidemiology of blunt lower urinary tract trauma with and without pelvic fracture. Urology 2017;102:234-239. Y. Yamakawa, et al. Nonunion fragility fracture of the pelvis with complication from bladder rupture: A case report. Trauma Case Reports 2019;20:100169

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