Bladder Problems in Pelvic Injuries Treated with External Fixator and Direct Urethral Drainage

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Abstract
In the treatment of unstable pelvic fractures, external fixators provide the advantages of substantial pain relief, easier nursing care, early mobilization, decreased hospital stay, and direct access to open wounds. Urethral catheter drainage alone for ruptured bladders obviates the need for open surgical repair in a critically injured patient and reduces morbidity and pain. Three cases are reported with bladder complications arising from these recently advocated methods of management; two with external fixators and one with urethral catheter drainage. In one patient with an external fixator, stretching of the bladder over a bone fragment resulted in transient hematuria with activity. In a second patient, the protruding bladder wall was caught between opposing pubic rami. In an extraperitoneal bladder rupture with pubic rami fractures, urethral catheter drainage alone resulted in a pseudodiverticulum of the bladder with a bone fragment projecting through the hole in the bladder cavity. These cases illustrate some complications with these recently advocated methods of management of unstable pelvic fracture and ruptured bladder.

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