The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

New Onset Urological Complication in Pelvic Fractures: Predictors of Bladder Injury, Urethral Injury, Urinary Retention and Urinary Incontinence Following Pelvic Fractures

Document Type : RESEARCH PAPER

Authors
Mohammed Dashti 1
Abdullah Almutairi 2
Saad Alenezi 1
Barak Alenezi 1
Ahmed Alshammasi 3
Bassam Almulla 4
AlJarrah Aleidan 5
1 Department of Orthopedic Surgery, Jaber Al-Ahmad Hospital, Kuwait
2 Department of Orthopedic Surgery, Farwaniya Hospital, Kuwait
3 Department of orthopedic Surgery, Jaber Al-Ahmad Hospital, Kuwait
4 Al-Razi Orthopedic Hospital, Kuwait
5 Department of orthopedic Surgery, Jaber Hospital, Kuwait
10.22038/abjs.2025.89334.4058
Abstract
Objectives: This study aims to identify the incidence of urological complications named bladder injury, urethral injury, urinary retention, and urinary incontinence following pelvic fractures and e xamine age, sex, fracture type, and mechanism of injury as possible predictors.
Methods: A retrospective cohort study was conducted at two general hospitals, including patients with pelvic ring fractures between January 2021 and March 2024. Data were gathered using the patients’ files.
Results: A total of 45 patients were included. 2 (4.4%) had urethral injury, 4 (8.9%) had bladder injury, 6 (13.3%) had urinary incontinence, and 2 (4.4%) had urinary retention. Neither age nor sex showed a statistically significant difference. Anteroposterior compression type III (APC III) injuries were disproportionately associated with urological complications, namely one urethral injury, three bladder injuries, and two urinary retention cases. Patients with APC III injuries had an increased probability of sustaining bladder injuries (OR- 15, p = 0.057). In terms of mechanisms of injury, road traffic accidents, falls from height, injuries with heavy objects, and falls from stairs were the most common, accounting for 51% of the cases. However, a fall from stairs was identified as the only mechanism of injury (MOI) that showed a lower odds of urethral injury, which is statistically significant; however, due to the rarity of complications as well as small sample size, the odds ratio calculations are known to be dubious with a resultant high variance and wide confidence interval, therefore further studies are required to confirm findings.
Conclusion: This study shows a significant association between APC III pelvic fractures and bladder injuries and urinary retention. The results show that the type of fracture and its mechanism of injury play a more significant role in predicting urogenital complications, compared to factors like age and gender. Early diagnostic interventions and management strategies based on these factors are essential for improving patient outcomes. Although the study provides valuable insights, further research with a larger sample size is needed to develop predictive models for more effective management.
Level of evidence: III
Keywords
Bladder injury
Pelvic fracture
Urinary incontinence
Urethral injury
Urinary retention
Subjects
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The Archives of Bone and Joint Surgery
Volume 14, Issue 9
September 2026
Pages 597-606

  • Receive Date 24 July 2025
  • Revise Date 05 January 2026
  • Accept Date 25 November 2025