Complications of Surgically Treated Pelvic Ring Injuries with Associated Genitourinary Injuries

Published:January 17, 2023DOI:


      • Having concomitant pelvic ring injuries and genitourinary injuries resulted in an increase rate of post operative complications.
      • Timing of surgical intervention was not associated with post operative complications.
      • Medical co-morbidities, age, injury severity score, length of stay were not associated with an increased post operative complication rate.



      Pelvic ring injuries are often associated with vascular and intrapelvic organ injuries including damage to the genitourinary system. The purpose of this study was to examine the relationship between surgically treated pelvic ring injuries and genitourinary injuries. The primary outcome was to determine the rate of post-operative complications including infection, urinary dysfunction, and sexual dysfunction. The secondary outcome was to determine if the time to surgery was associated with post-operative complications.


      Retrospective chart review from September 1, 2015 to December 31, 2019 of patients who sustained a pelvic ring injury which required surgical intervention. All patients with closed triradiate cartilage were included.


      A total of 115 patients met the inclusion criteria, 12 patients with an associated genitourinary (GU) injury were included in the GU group and 103 without GU injury were placed in the non-GU group. The median (range) age of patients in the GU group was 49.5 years (20, 64) and 48 years (15, 92) in the control group (p=0.92). Demographic characteristics including age, Injury Severity Score and Elixhauser comorbidity score were similar between groups. Within the GU group, five patients had an injury to their bladder, four to their urethra and three had an injury to their kidney. In the GU group, one patient developed a wound dehiscence and one developed a urinary tract infection with subsequent sepsis (17%), while in the non-GU group, one patient (1%) developed erectile dysfunction (p=0.028). Regression analysis demonstrated that having concomitant pelvic ring and GU injuries, as well as the number of surgeries were variables associated with post-operative complications, while time to surgery was not.

      Discussion and Conclusions

      Pelvic ring injuries with concomitant genitourinary injuries were associated with increased odds of post-operative complications. No differences were noted in complication rates due to the time to surgery between groups.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Lewis CL
        • Laudicina NM
        • Khuu A
        • Loverro KL.
        The Human Pelvis: Variation in Structure and Function During Gait.
        Anat Rec. 2017; 300: 633-642
        • Balogh Z
        • King KL
        • Mackay P
        • et al.
        The epidemiology of pelvic ring fractures: A population-based study.
        J Trauma - Inj Infect Crit Care. 2007; 63: 1066-1072
        • Buller LT
        • Best MJ
        • Quinnan SM.
        A Nationwide Analysis of Pelvic Ring Fractures.
        Geriatr Orthop Surg Rehabil. 2016; 7: 9-17
        • Mi M
        • Kanakaris NK
        • Wu X
        • Giannoudis P V
        Management and outcomes of open pelvic fractures: An update.
        Injury. 2021; 52: 2738-2745
        • Neufeld ME
        • Broekhuyse HM
        • OʼBrien PJ
        • Guy P
        • Lefaivre KA.
        The Longitudinal Short-, Medium-, and Long-Term Functional Recovery After Unstable Pelvic Ring Injuries.
        J Orthop Trauma. 2019; 33: 608-613
        • Figler B
        • Edward Hoffler C
        • Reisman W
        • et al.
        Multi-disciplinary update on pelvic fracture associated bladder and urethral injuries.
        Injury. 2012; 43: 1242-1249
        • Ramasamy A
        • Evans S
        • Kendrew JM
        • Cooper J.
        The Open Blast Pelvis The Significant Burden of Management.
        J BONE Jt Surg. 2012; 94: 829-835
        • Leenen LPH.
        Pelvic Fractures : Soft Tissue Trauma.
        Eur J Trauma Emerg Surg. 2010; : 117-123
        • Brandes S
        • Borrelli J.
        Pelvic fracture and associated urologic injuries.
        World J Surg. 2001; 25: 1578-1587
        • Koraitim MM.
        Pelvic fracture urethral injuries: The unresolved controversy.
        J Urol. 1999; 161: 1433-1441
        • Van Walraven C
        • Austin PC
        • Jennings A
        • Quan H
        • Forster AJ.
        A modification of the elixhauser comorbidity measures into a point system for hospital death using administrative data.
        Med Care. 2009; 47: 626-633
        • Ondeck NT
        • Bovonratwet P
        • Ibe IK
        • et al.
        Discriminative Ability for Adverse Outcomes after Surgical Management of Hip Fractures: A Comparison of the Charlson Comorbidity Index, Elixhauser Comorbidity Measure, and Modified Frailty Index.
        J Orthop Trauma. 2018; 32: 231-237
        • Menendez ME
        • Ring D
        • Harris MB
        • Cha TD.
        Predicting in-hospital mortality in elderly patients with cervical spine fractures: A comparison of the charlson and elixhauser comorbidity measures.
        Spine (Phila Pa 1976). 2015; 40: 809-815
        • Menendez ME
        • Ring D.
        A Comparison of the Charlson and Elixhauser Comorbidity Measures to Predict Inpatient Mortality after Proximal Humerus Fracture.
        J Orthop Trauma. 2015; 29: 488-493
        • Ranson WA
        • Neifert SN
        • Cheung ZB
        • Mikhail CM
        • Caridi JM
        • Cho SK.
        Predicting In-Hospital Complications After Anterior Cervical Discectomy and Fusion: A Comparison of the Elixhauser and Charlson Comorbidity Indices.
        World Neurosurg. 2020; 134: e487-e496
        • Kim CY
        • Sivasundaram L
        • LaBelle MW
        • Trivedi NN
        • Liu RW
        • Gillespie RJ.
        Predicting adverse events, length of stay, and discharge disposition following shoulder arthroplasty: a comparison of the Elixhauser Comorbidity Measure and Charlson Comorbidity Index.
        J Shoulder Elb Surg. 2018; 27: 1748-1755
        • Elixhauser A
        • Steiner C
        • Harris DR
        • Coffey RM.
        Comorbidity Measures for Use with Administrative Data.
        Med Care. 1998; 36: 8-27
        • Johnsen N.V.
        • Vanni AJ
        • Voelzke BB.
        Risk of infectious complications in pelvic fracture urethral injury patients managed with internal fixation and suprapubic catheter placement.
        J Trauma Acute Care Surg. 2018; 85: 536-540
        • Kazley JM
        • Potenza MA
        • Marthy AG
        • Arain AR
        • O'Connor CM
        • Czajka CM
        Team approach: Evaluation and management of pelvic ring injuries.
        JBJS Rev. 2020; 8: 1-9
        • Routt ML
        • Simonian PT
        • Defalco AJ
        • Miller J
        • Clarke T.
        Internal fixation in pelvic fractures and primary repairs of associated genitourinary disruptions: a team approach.
        J Trauma. 1996; 40: 784-790
        • Watnik NF
        • Coburn M
        • Goldberger M.
        Urologic injuries in pelvic ring disruptions.
        Clin Orthop Relat Res. 1996; 4: 37-45
        • Kotkin L
        • Koch MO.
        Morbidity associated with nonoperative management of extraperitoneal bladder injuries.
        J Trauma. 1995; 38: 895-898
        • Johnsen N.V.
        • Dmochowski RR
        • Young JB
        • Guillamondegui OD.
        Epidemiology of Blunt Lower Urinary Tract Trauma With and Without Pelvic Fracture.
        Urology. 2017; 102: 234-239
        • Koraitim MM
        • Marzouk ME
        • Atta MA
        • Orabi SS.
        Risk factors and mechanism of urethral injury in pelvic fractures.
        Br J Urol. 1996; 77: 876-880
        • Aihara R
        • Blansfield JS
        • Millham FH
        • LaMorte WW
        • Hirsch EF.
        Fracture locations influence the likelihood of rectal and lower urinary tract injuries in patients sustaining pelvic fractures.
        J Trauma. 2002; 52: 205-209
        • Cannada LK
        • Taylor RM
        • Reddix R
        • Mullis B
        • Moghadamian E
        • Erickson M.
        The Jones-Powell classification of open pelvic fractures: A multicenter study evaluating mortality rates.
        J Trauma Acute Care Surg. 2013; 74: 901-906
        • Fu CY
        • Huang RY
        • Wang SY
        • et al.
        Concomitant external and internal hemorrhage: Challenges to managing patients with open pelvic fracture.
        Am J Emerg Med. 2018; 36: 1937-1942
        • Andrich DE
        • Day AC
        • Mundy AR.
        Proposed mechanisms of lower urinary tract injury in fractures of the pelvic ring.
        BJU Int. 2007; 100: 567-573
        • Dente CJ
        • Feliciano D.V.
        • Rozycki GS
        • et al.
        The outcome of open pelvic fractures in the modern era.
        Am J Surg. 2005; 190: 831-837
        • Ochenjele G
        • Reid KR
        • Castillo RC
        • et al.
        Predictors of unplanned reoperation after operative treatment of pelvic ring injuries.
        J Orthop Trauma. 2018; 32: E245-E250
        • Jones AL
        • Powell JN
        • Kellam JF
        • McCormack RG
        • Dust W
        • Wimmer P.
        Open pelvic fractures: A multicenter retrospective analysis.
        Orthop Clin North Am. 1997; 28: 345-350