Pelvic fractures with urethral rupture

Case contributed by RMH Core Conditions


Driver. Motor vehicle collision.

Patient Data

Age: 23
Gender: Male


Mediastinal contours are consistent with technique. Lungs and pleural spaces are clear. No pneumothorax or displaced rib fractures detected.

Left sacral ala fracture. Equivocal right SI joint widening. Pubic symphysis diastasis with the left pubic bone lying superior to the right pubic bone. Pelvic binder in-situ. 


On the pre-contrast study, there is a small amount of extravasated contrast within the retro-pubic space (cave of Retzius), inferior extraperitoneal pelvic cavity and tracking into the perineum/perineal muscles and adductor musculature of the left thigh. This is consistent with the known urethral rupture seen on the prior urethrogram. Post-stress cystogram, there is further contrast extravasation into the right extraperitoneal space. No intraperitoneal contrast extravasation to suggest intraperitoneal bladder rupture.

A moderate volume of extraperitoneal pelvic hematoma is demonstrated, partially mixed with the extravasated contrast and presumably urine. There is further pooling of the extravasated contrast on the intravenous-contrast enhanced study, particularly posterosuperiorly anterior to and within the right SI joint.

A tiny volume of intraperitoneal hematoma is demonstrated in the subhepatic/perihepatic space, inferior to the right liver lobe. No definite liver, splenic or renal laceration identified to explain this.

No other evidence of solid or hollow organ abdominal visceral injury.

A comminuted, minimally displaced fracture of the left sacral body and sacral ala is present, with intra-articular extension into the left SI joint and involvement of the left S1 and S2 nerve root foraminae. 11 mm fracture fragment displaced into the left posterior pelvis anterior to the left sacral ala. There is mild widening/diastasis of the right SI joint (upto 7 mm). There is associated diastasis of the pubic symphysis with the left pubic bone superior to the right. Possible subtle left pubis fracture.

Left laterally displaced L5 transverse process fracture.

Case Discussion

This fracture is an example of an open-book pelvic fracture, although it is less obvious given it has been reduced by the pelvic binder. 

Urethral injury is a major complication of these types of fractures. Active pelvic bleeding should also be actively assessed for with pelvic fractures. 

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