Pelvic fracture urethral injuries in children and adults

ABSTRACT

We attempted to identify the particular features of pelvic fracture urethral injuries in children compared to adults. A total of 43 boys, 2 to 15 years old, with pelvic fracture, were studied prospectively. This is a subset of a series of 203 consecutive male patients, 2-80 years old, with fracture of the bony pelvis. All patients underwent radiographic examination of the pelvis while retrograde urethrography was performed in 194 patients. The most common types, of pelvic fracture in children were Malgaigne's [32.6%] and straddle [23.2%] fractures. Urethral injury was found in 13 children [30%] in the form of stretching of an intact posterior urethra in 1 case [8%], partial rupture in 3 [23%], and complete rupture in 9 [69%]. In 3 of the partial rupture cases, injury involved the prostatic urethra or bladder neck. Whereas the more serious fractures, were more common in children [56 versus 24%], the less serious fractures were more common in older patient [76 versus 44%] [p < 0.05]. In children, associated urethral injury is more frequent [30 versus 24%], more likely to be a complete rupture [69 vs 42%], and with a higher incidence of prostatic displacement [22.2 versus 18.7%] than in adults. Injury of the prostatic urethra or bladder neck is peculiar to the children group