SAQ 87 – Trauma – pelvic fracture with retrograde cystogram

Question 2. pelvic fracture with retrograde cystogram.

a. X-ray abnormalities

• Left superior pubic ramus fracture.
• Left inferior pubic ramus fracture.
• Pubic symphysis diastasis.
• Left sacral fracture.
• Indistinct superior bladder contour suggesting bladder rupture.

b. FAST advantages

• Free fluid would support bladder rupture or other intra-abdominal bleeding.
• Immediate bedside result may accelerate disposition, CT, theatre, or interventional radiology decisions.
• Can be performed in the ED without moving the unstable patient.
• Non-invasive, repeatable, and avoids radiation and contrast.
• A positive scan may increase urgency of surgical response.

c. FAST limitations

• False negatives occur with small volume bleeding.
• Poor for retroperitoneal injuries.
• Poor for hollow viscus injuries.
• False positives may occur with ascites or pre-existing free fluid.
• Operator, training, credentialing, and body habitus dependent.