Trauma pelvic

Cerebrovascular accidents Cervical spondylosis Multiple sclerosis Parkinson s disease Pelvic trauma... 

Pelvic trauma in children can result in a wide variety of different fractures and soft tissue injuries these range from isolated, relatively henign avulsion injuries to very complex multiple pelvic fractures and joint dissociations. The type of injury will depend on the causative mechanism as well as the age and development of the child. Compared with adults, pelvic fractures are relatively uncommon in children (ScHLiCKWEi and Keck 2005) and indicate a significant high energy impact. 

In adults, the morbidity rate in pelvic trauma ranges between 5% and 15% but may reach 50% in some cases. In 12% of cases, the death is attributable to the pelvic trauma. In children, the death rate is lower (SiLBER et al. 2001) and the morbidity mostly the result of associated head and neck injuries. 

Berg EE, Chebuhar C, et al. (1996) Pelvic trauma imaging a blinded comparison of computed tomography and roentgenograms. J Trauma 41 994-998 Bond SJ, Gotscball CS, et al. (1991) Predictors of abdominal injury in children with pelvic fracture. J Trauma 31 1169-1173... 

Leungwattanakij S, Bivalacqua TJ, Usta MF et al (2003) Cavernous neurotomy causes hypoxia and fibrosis in rat corpus cavernosum. J Androl 24 239-245 Levine FJ, Greenfield AJ, Goldstein 1 (1990) Arteriographi-cally determined occlusive disease within the hypogastric-cavernous bed in impotent patients following blunt perineal and pelvic trauma. J Urol 144 1147-1153 Lue TF (2000) Erectile dysfunction. N Engl J Med 342 1802-1813... 

This situation is less common than low-flow priapism and can be classified as congenital due to arterial malformations, traumatic usually associated with penile, perineal or pelvic trauma, iatrogenic following revascularization procedures or idiopathic. The local blood gas tension in these patients is arterial, and therefore the penis is not at risk of ischemia and subsequent fibrosis. 

Posterior urethra can be injured in patients with pelvic traumas. Precise definition of pelvic fracture location may enable prediction of which subjects are at risk for posterior urethral injury (Basta et al. 2007). 

CT has a limited role in the evaluation of the urethra. Certain urethral abnormalities such as calculi or diverticula may be incidentally discovered at CT performed for other indications. CT is useful in patients with pelvic trauma (Chou et al. 2005) and associated urethral injuries and for staging of urethral carcinoma. CT virtual cystoscopy and voiding urethrography can be indicated in patients with complex urethral strictures and malformations. 

Ptak T, Rhea JT, Novelline RA (2003) Radiation dose is reduced with a single-pass whole-body multi-detector row CT trauma protocol compared with a conventional segmented method initial experience. Radiology 229 902-905 Resnik CS, Stackhouse DJ, Shanmuganathan K etal. (1992) Diagnosis of pelvic fractures in patients with acute pelvic trauma efficacy of plain radiographs. AJR Am J Roentgenol 158 109-112... 

Embolization, by definition, reduces blood flow distally. Therefore, it is no surprise that distal necrosis is a recognized complication of trauma embolization. However, unintentional reflux of embolization material from the internal iliac into the femoral artery can cause inadvertent ischemia in the leg. Sciatic palsy with associated foot drop and sacral plexus palsy has been reported [57]. Embolization of the superior gluteal artery in a patient vdio will be subjected to prolonged bedrest may cause sacral and buttock ischemia leading to skin break down [58]. Sexual dysfunction seems not to he a complication of bilateral internal iliac artery embolization, but is more likely a result of nerve injury secondary to the fracture or pelvic trauma [59]. 

Kadish LJ, Stein JM et al. (1973) Angiographic diagnosis and treatment of bleeding due to pelvic trauma. J Trauma 13(12) 1083-5... 

Shanmuganathan K, Mirvis SE et al. (1993) Value of contrast-enhanced CT in detecting active hemorrhage in patients with blunt abdominal or pelvic trauma. AJR Am J Roentgenol 161(l) 65-9... 

Ravitch MM (1964) Hypogastric Artery Ligation in Acute Pelvic Trauma. Surgery 56 601-2... 

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