Timely X-rays could make it faster to identify people who have had a bladder injury after breaking their pelvis, new research suggests.
This would mean they could be quickly referred to a urologist for treatment, as well as saving them from having more invasive tests.
Orthopaedic specialists from Northern Care Alliance, Manchester University NHS Foundation Trust and The University of Manchester carried out the study using records from 600 patients treated at two local trauma centres. Their investigation showed that when X-rays identified leaking of fluid from a vein into the surrounding tissue (extravasation), this strongly correlated with bladder injury. X-rays within 10 hours of a CT scan were more reliable.
Current British Orthopaedic Association Standards for Trauma (BOAST) say that all patients with pelvic fractures should undergo a contrasted tomography (CT) scan and X-ray after removal of pelvic binders (PBXR) – these provide compression around the pelvis after an injury to stabilise the pelvis and help prevent haemorrhaging.
Retrospective study
According to the guidelines, retrograde cystography (a type of scan where a flexible catheter is inserted into the bladder) is recommended to investigate suspected bladder injury. But this is an invasive procedure that is not easy to perform in polytrauma patients.
That’s why the researchers carried out the retrospective study looking at patients admitted with pelvic fractures between July 2021 and December 2024.
Of the 186 patients who had had both a whole-body CT scan and a PBXR, five had bladder injuries. Of those five, four patients showed contrast extravasation on the PBXR and one did not. No patients without a bladder injury showed contrast extravasation, suggesting PBXR is effective in detecting bladder injury.
The researchers have recommended a larger study should now take place to provide further evidence for updating the guidelines.
The work has been published in the journal Injury. NCA’s authors were Elgenaid Ahmed, Syed Hassan, Vijaya Kempanna (main picture, right), Inder Gill (main picture, left) and Mohammed Iqbal.
Other recent research papers co-authored by the trauma and orthopaedics team include:
- Management of acetabular fractures in elderly patients (Journal of Clinical Orthopaedics & Trauma).
- Acute total hip arthroplasty for acetabular fractures in the elderly – Review of surgical strategies and recent trends (Journal of Clinical Orthopaedics & Trauma).
- Minimally invasive prophylactic plating for bisphosphonate-induced atypical femoral fracture post total hip replacement (Journal of Orthopaedic Case Reports).
- Intertrochanteric fracture fixation using a traction table in a patient with ipsilateral above-knee amputation – A case report and review of reduction techniques (Journal of Orthopaedic Case Reports).
- Evolving practice in management of pelvic-acetabular trauma: Covid-19 experience from a tertiary referral centre in the UK (Cureus).