Hidden dangers of pelvic fracture: A meta-analysis on urinary tract injury incidence and risk factors.

IF 2 Q2 ORTHOPEDICS World Journal of Orthopedics Pub Date : 2025-02-18 DOI:10.5312/wjo.v16.i2.102483

Gonzalo Mariscal, Ali Dway, Carlos Barrios

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Abstract

Background: Pelvic fractures are often associated with significant morbidity, including injuries to the urinary tract. Understanding the incidence and risk factors for urinary tract injury in these patients is crucial for prompt diagnosis and management. This meta-analysis aims to synthesize existing evidence to determine the overall incidence and identify specific risk factors associated with urinary tract injuries in patients with pelvic fractures.

Aim: To determine the incidence and risk factors for urinary tract injuries in patients with pelvic fractures.

Methods: A systematic search of PubMed, EMBASE, Scopus, and the Cochrane Library was conducted without date restrictions. Studies examining the incidence and risk factors of urinary tract injuries in patients with pelvic fractures were included. Data extracted included demographics, injury mechanism, pelvic fracture type, urinary tract injury incidence, mortality, and discharge disposition. Review Manager 5.4 was used for data analysis.

Results: Ten studies comprising 22700 patients were included. The pooled incidence of urinary tract injury associated with pelvic fracture was 6.88% (95%CI: 6.20%-7.55%). Vehicle, motorcycle, and pedestrian accidents were identified as risk factors for urinary tract injury, with relative risks (RR) of 1.08 (95%CI: 1.06-1.11), 1.89 (95%CI: 1.78-2.00), and 1.53 (95%CI: 1.20-1.95), respectively. Pubic fracture and pelvic ring disruption were significantly associated with urinary tract injury [odds ratio (OR) 1.94, 95%CI: 1.09-3.44 and OR 5.53, 95%CI: 4.67-6.54, respectively)]. Patients without urinary tract injury were more likely to be discharged home (RR 0.79, 95%CI: 0.67-0.92). Mortality was higher in patients with urinary tract injury (OR 1.92, 95%CI: 1.77-2.09).

Conclusion: Urinary tract injury occurs in nearly 7% of patients with pelvic fractures. Motorcycle accidents, pubic fractures, and pelvic ring disruptions are significant risk factors. Urinary tract injury following pelvic fracture is associated with increased mortality.

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