Trauma

Question 1

How many classes of renal injury are there?

Answer 1

5 (I - V)

Question 2

What is class I renal injury

Answer 2

Haematoma, subcapsular, non-expanding, no parenchyman laceration

Question 3

What is class II renal injury

Answer 3

Laceration <1cm perenchymal depth witjout urinary extravasation

Question 4

What is class III renal injury

Answer 4

> 1cm depth, no collecting system rupture or extraversion

Question 5

What is class IV renal injury

Answer 5

Laceration through cortex, medulla and collecting system, main arterial/venous injury with contained haemorrhage

Question 6

What is class V renal injury

Answer 6

Shattered kidney, avulsion of hilum, devascularising kidney

Question 7

What are some indications for CT with contrast in suspected renal injury

Answer 7

• Frank haematuria in adult
• Frank or occult haematuria in a child
• Occult haematuria and systolic <90 mmHg at any point
• Penetrating injurt with any degree with contrast

Question 8

How are most cases of renal injury managed?

Answer 8

Angiography/embolisation (Non-surgical)W

Question 9

What are some indications for surgery in renal injury?

Answer 9

• Persistent renal bleeding, expanding perirenal haematoma, pulsatile perirenal haematoma
• Urinary extravasion, non-viable tissue, incomplete staging

Question 10

What is the most common cause of bladder trauma?

Answer 10

Pelvic fracture

Question 11

How will bladder injury usually present?

Answer 11

• Suprapubic/abdominal pain + inability to void
• Suprapubic tenderness, lower abdominal bruising, guarding/rigidity, diminished bowel sounds

Question 12

What investigations are required in bladder injury?

Answer 12

Urinalysis
Retrograde urethrogram
CT cystography

Question 13

What will be seen on CT cystography in extra-peritoneal injury?

Answer 13

Flame-shaped collection of contrast in the pelvis

Question 14

How is bladder injury managed?

Answer 14

• Large-bore catheter
• Antibiotics
• Repeat cystogram in 14 days
• Immediate surgical repair indicated in some cases e.g. intraperitoneal injury, penetrating injury

Question 15

What are some indications for immediate surgical repair in bladder injury?

Answer 15

Intraperitoneal injury
Penetrating injury

Question 16

What is the most common cause of posterior urethral injury?

Answer 16

Fracture of the pubic rami

Question 17

What part of the posterior urethral is most vulnerable to trauma?

Answer 17

Post. urethra fixed at urogenital diaphragm and puboprostatic ligaments, so bulbomembranous junction most vulnerable

Junction where bulbous urethra and membranous urethra meet

Question 18

How does urethral injury present?

Answer 18

• Blood at meatus
• Inability to urinate
• Palpably full bladder
• ‘High-riding’ prostate
• Butterfly perineal haematoma

Question 19

What is the main investigation used in urethral injury?

Answer 19

Retrograde urethrogram

Question 20

What are some indications for immediate surgical repair of urethral injury?

Answer 20

• Intraperitoneal injury
• Penetrating injury
• Inadequate drainage or clots in urine
• Bladder neck injury
• Rectal or naginal injury
• Open pelvic fracture
• Pelvic fracture requiring open reduction/fixation
• Patients undergoing laparotomy for other reasons
• Bone fragments projecting into the bladder

Question 21

How is urethral injury usually managed?

Answer 21

• Suprapubic catheter
• Delayed reconstruction after at least 3 months

Question 22

What is the most common cause of penile fracture?

Answer 22

Typically happens during intercourse - buckling injury when penis slips out of vagina and strikes pubis

Question 23

How will penile fracture present?

Answer 23

• Cracking or popping sound followed by pain, rapid detumescence, discolouration and swelling
• 20% evidence of urethral injury (frank haematuria/blood at meatus)

Question 24

How is penile fracture managed?

Answer 24

• Prompt exploration and repair
• Circumcision incision with degloving of penis to expose all 3 compartments

Question 25

How will testicular injury usually present?

Answer 25

- Usually presents with pain and nausea - Swelling/bruising variable

Question 26

What investigations are required in testicular injury?

Answer 26

USS to assess integrity/vascularity

Question 27

How is testicular injury managed?

Answer 27

Early exploration/repair - better outcome