title: Urological injuries associated with pelvic fractures: A case report of a detached bone segment inside the bladder.
abstract: BACKGROUND
  Urological injuries in pelvic fractures are noticed in 6-15% of the cases. The bladder, due to its anatomical position, is prone to rupture in pelvic fractures. The majority of urinary bladder injuries are either extraperitoneal or intraperitoneal. Nonetheless, both types can occur simultaneously in 6% of the cases.
  
  
  METHODS
  A 45-year-old male was brought to our emergency department after being struck by an automobile. In the absence of signs of urethral injury, a Foley's catheter was inserted revealing gross hematuria. The radiological assessment showed bilateral non-displacement sacral wing fractures, bilateral non-displacement anterior column fractures and bilateral comminuted superior and inferior pubic rami fractures, with a detached pubic bone fragment displaced posteriorly. A CT cystogram was performed showing intraperitoneal and extraperitoneal extravasation of contrast. The patient was taken to surgery. A sharp-edged bony fragment was discovered inside the bladder. A two-layer closure of the bladder was performed.
  
  
  CONCLUSIONS
  Pelvic fractures with concomitant lower urinary tract injuries are associated with high morbidity and mortality. The signs indicative of bladder rupture include a more than one centimeter diastasis of the symphysis pubis and a displaced fracture of more than one centimeter involving the obturator ring. However, the signs may not be present as in our case.
  
  
  CONCLUSIONS
  This unusual case illustrates the potential risk of bladder injury following stable pelvic fractures through a detached bone segment. It also emphasizes on having a high index of suspicion. The teamwork and multidisciplinary approach are essential for an optimal outcome.
authors.affiliation: Orthopedic Department, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia. Electronic address: alfayezsaud@gmail.com.
authors.forename: Saud M
authors.initials: SM
authors.lastname: Alfayez
authors.affiliation: Department of Orthopedics, King Saud Medical City, Riyadh, Saudi Arabia.
authors.forename: Khalid
authors.initials: K
authors.lastname: Allimmia
authors.affiliation: Department of Orthopedics, King Saud Medical City, Riyadh, Saudi Arabia.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Alshammri
authors.affiliation: Department of Orthopedics, King Saud Medical City, Riyadh, Saudi Arabia.
authors.forename: Firas
authors.initials: F
authors.lastname: Serro
authors.affiliation: Orthopedic Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors.forename: Rakan
authors.initials: R
authors.lastname: Almogbel
authors.affiliation: Orthopedic Department, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Bin Dous
authors.affiliation: Division of Urology, Department of Surgery, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Raed
authors.initials: R
authors.lastname: Almannie
authors.affiliation: University Hospital of Valladolid, Valladolid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Palencia
keywords: Bladder rupture; Case report; Detached bone; Hematuria; Pelvic fracture