Place patient in 25–30-degree oblique position.

Get some (water soluble) contrast media from radiology.

Posteriorly: ( Most common injury – up to 25% of pelvic fractures) Anatomyīefore looking at the technique, it’s worth having a refresh on the anatomy, just so we know what we’re looking for. Now, I remember quoting the above list in my first ATLS course (In 2009? Oh my.), but as fresh-faced PGY-2 I’ll admit thinking of it as some difficult, fancy imaging technique that I would need to beg some clever radiologist to perform, I had no idea that it was actually pretty easy and could be done in a trauma bay using the overhead X-Ray.

Unstable pelvic fractures (particularly with symphysis diastasis (1), straddle fractures and Malgaigne fractures)Īny of the above and you should be checking out that urethra.

80% are associated with vaginal laceration or blood at the introitus (2)) – skip the RUG and get the urologists involved.īack to the blokes, if you remember back to your ATLS/EMST course they quote: If you think there are signs of urethral injury in a female patient (approx. 97% of urethral injuries occur in male patients (1) due to the shorter female urethra being less prone to shearing stresses. Poking at it can cause it to become a complete transection = very bad)įirstly, men.

Can be made worse with insertion of a urinary catheter (partial tear = bad.

Bad if missed (just ask a urologist – they hate managing urethral strictures).

Urethral injury is a common complication, up to 24%, of pelvic fractures.

This came up in a few discussions in our Grand Rounds sessions last year, so I thought it would be useful to do a quick refresher on the technique. When our patients are haemodynamically behaving themselves, and don’t have active bleeding we can take a breath and relax and think about, amongst other things, getting a urinary catheter in the patient…and that’s when we should be thinking about a retrograde urethrogram (RUG). From a trauma resuscitation perspective, we’re usually most concerned with whether a pelvic injury is unstable with disruption of the pelvic ring, and if there is active arterial bleeding. Pelvic fractures are pretty common, particularly if you work in a trauma centre.

Retrograde urethrogram