PMC4115162_01
Open book pelvic fracture.
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F1
An anterior-posterior (AP) pelvic film radiograph showed a Type B1, unstable antero-posterior compression fracture (open -book) with a separation of the pubic symphysis of about 8 cm (Figure 1).
Injuries of the urethra[]. A: The normal anatomy of the bladder, prostate, perineal membrane and puboprostatic ligaments. B: The pelvis is fractured and the puboprostatic ligament is ruptured but the urethra is only stretched and bruised. C: The pelvis is fractured and the puboprostatic ligament disrupted and there is complete tear through the membranous part of the urethra but the perineal ligament is intact. D: The pelvis is fractured, both puboprostatic and perineal ligaments are disrupted and there is a complete tear which involves the membranous and bulbous part of the urethra with an upward and backward dislocation of the prostate and bladder.
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F2
External fixation and reduction.
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F3
The following day the patient benefited from the insertion of an external fixator under local anaesthesia for stabilisation of the fracture dislocation of the pelvic ring and thereby protecting the anastomosis (Figure 3).
Scrotal wound: 2 months post excised necrotizing fasciitis complicating urinary extevasation- healing by second intention.
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F4
He was put on a further two week course of intravenous ceftriaxone and metronidazole and the scrotal wound almost completely healed in a month (Figure 4).
Retrograde cystogram: 2 months post posterior urethra repair.
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F5
2 months post urethral repair, a retrograde cystourethrogram revealed a completely healed anastomosis (Figures 5 and 6).
Retrograde cystourethrogram:
arrow shows site of anastomosis
.
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F6
2 months post urethral repair, a retrograde cystourethrogram revealed a completely healed anastomosis (Figures 5 and 6).