JAAOS - 2026-05-28 - Journal Article
Management of Pelvic Fractures With Urogenital Injuries.
Cantrell CK, Flanagan CD, Mir HR
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Key Takeaway
Urogenital injuries complicate 6-16% of pelvic fractures, and modern evidence supports selected internal fixation over historical external fixation preference without increased infection risk.
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Summary
This narrative review examines the diagnosis, acute management, and long-term sequelae of urogenital injuries associated with pelvic ring fractures. Retrograde urethrogram and cystography remain diagnostic benchmarks; pubic symphysis diastasis is highlighted as highly predictive of urogenital involvement. Urethral injuries, more common in men affecting the posterior urethra, are managed with endoscopic realignment or suprapubic diversion with delayed reconstruction, while bladder injuries are stratified to catheter drainage versus operative repair.
Key Limitation
No primary data or meta-analytic synthesis is provided, so the claim that internal fixation carries no increased infection risk in the setting of bladder injury is not quantitatively substantiated within this article.
Original Abstract
Pelvic ring injuries are frequently associated with concomitant bladder and urethral damage due to the anatomic proximity of the urogenital system. Urogenital injuries occur in approximately 6% to 16% of pelvic fractures and are linked to increased morbidity and mortality. Diagnosis relies on a combination of physical examination, urinalysis, and imaging, with retrograde urethrogram and cystography serving as benchmarks. Lateral compression and AP compression injuries are both associated with urogenital injuries. Specific fracture characteristics, including pubic symphysis diastasis, are highly predictive of urogenital involvement. Bladder injury management ranges from catheter drainage to surgical repair depending on the degree and location of injury. Urethral trauma is more common in men, particularly affecting the posterior urethra, and is managed with either endoscopic realignment or suprapubic diversion with delayed reconstruction. Long-term consequences include excretory and sexual dysfunction, often linked to fracture displacement, nerve injury, or psychological factors, underscoring the importance of multidisciplinary care. Historically, external fixation was preferred for pelvic stabilization in the setting of bladder injury; however, modern evidence supports selected use of internal fixation without increased infection risk. Coordinated orthopaedic-urologic management remains essential to optimize functional and quality-of-life outcomes.