Pelvic fractures

Pelvic fractures are complicated by severe hemorrhage and shock in up to 35 per cent of patients. The urethra is injured in 3 to 21 per cent of pelvic fracture in males, usually at the prostatic urethra. Bladder injury is reported in 10 per cent of patients with a pelvic fracture. Rupture is extraperitoneal in 60 per cent of patients, usually at the anterior wall or bladder neck. A full bladder (e.g. after alcohol consumption) usually perforates the dome intraperitoneally.

Another associated lesion is a hollow viscus tear which is reported in 1 to 3 per cent of patients. Rectal tears need to be addressed agressively with a proximal colostomy diversion to prevent pelvic abscesses (8-46 per cent), sepsis (8-15 per cent), and rectal fistulas (8-23 per cent). Injury to the non-pregnant uterus, vagina, ovaries, or Fallopian tubes may also be associated with pelvic fractures.

Owing to immobility, patients with pelvic fractures are at higher risk of thromboembolic disease than other trauma patients. This may be due to venous thrombosis in the lesser pelvis. Deep venous thrombosis is found in 6 per cent of patients, and pulmonary emboli are reported in 0.5 to 8.3 per cent of these.

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