Abstract
Introduction
Young adult males involved in motorcycle accidents are particularly at risk for posterior urethral injury whenever pelvic injury occurs. Posterior urethral injuries remain problematic because their diagnosis may be missed, and during the initial treatment response the urethral injury can be aggravated by urethral catheterization. Few anatomical and clinical tools exist that establish a correlation between injuries and fractures of the pelvic ring and the risk of posterior urethral injury.
Method
Based on experience with traffic accident modeling, a computerized finite element model was conceived integrating the specific anatomic structures concerned. This model was extrapolated from a CAT scan of a young adult. The anatomic structures concerned in urethral and pelvic ring trauma (PRT) were isolated, placed in 3D and given biomechanical properties. The model was verified according to available experiments on PRT.
Results
To apply the model, we recreated a lateral impact mechanism on the pelvic ring. Stretching between the prostatic and membranous portions of the urethra (before and after visualization of a pelvic fracture) as well as timing of injury was studied.
Conclusion
The model’s application permitted us to analyze precisely the link between lateral impact trauma of the pelvic ring and lesions of the posterior urethra and to identify an urethra stretching prior to visualization of a pelvic fracture. Utilization of the model with other mechanisms of injury should allow for better comprehension of this associated trauma, improved prevention, iatrogenic aggravation of, and care for, these serious injuries.
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References
Andrich DE, Day AC, Mundy AR (2007) Proposed mechanisms of lower urinary tract injury in fracture of the pelvic ring. BJU Int 100:567–573
Arnoux PJ, Serre T, Cheynel N, Thollon L, Behr M, Baque P et al (2008) Liver injuries in frontal crash situations a coupled numerical—experimental approach. Comput Methods Biomech Biomed Eng 11:189–203
Baqué P, Trojani C, Delotte J, Séjor E, Senni-Buratti M, Baqué F et al (2005) Anatomical consequences of “open-book” pelvic ring disruption: a cadaver experimental study. Surg Radiol Anat 27:487–490
Behr M, Arnoux PJ, Serre T, Bidal S, Kang HS, Thollon L et al (2003) A human model for road safety: from geometrical acquisition to model validation with radioss. Comput Methods Biomech Biomed Eng 6:263–273
Behr M, Thollon L, Arnoux PJ, Serre T, Berdah SV, Baque P et al (2006) 3D reconstruction of the diaphragm for virtual traumatology. Surg Radiol Anat 28:235–240
Bensalah K, Manunta A, Guillé F, Patard JJ (2006) Diagnosis and management of posterior urethra disruptions. Ann Urol (Paris) 40:309–316
Bidal S (2003) Reconstruction tridimensionelle d’éléments anatomiques et generation automatique de maillage elements finis optimises. Thèse de l’Université de la Méditerranée (France)
Bordenave M, Rouprêt M, Taksin L, Parra J, Cour F, Richard F et al (2011) Long-term results of the treatment of urinary incontinence with bulbar implantation of artificial urinary sphincter in men: a single-center experience. Prog Urol 21:277–282
Brooks JD, Chao WM, Kerr J (1998) Male pelvic anatomy reconstructed from the visible human data set. J Urol 159:868–872
Cheynel N, Serre T, Arnoux PJ, Ortega-Deballon P, Benoit L, Brunet C (2009) Comparison of the biomechanical behavior of the liver during frontal and lateral deceleration. J Trauma 67:40–44
Delotte J, Behr M, Thollon L, Arnoux PJ, Baque P, Bongain A et al (2007) Pregnant woman and road safety: a numerical approach. Application to a restrained third trimester pregnant woman in frontal impact. J Gynecol Obstet Biol Reprod (Paris) 36:577–581
De Peretti F, Cambas PM, Hovorka I, Veneau B, Argenson C (1994) Motorcycle petrol tanks and their role in severe pelvic injuries. Injury 25:223–225
Gokcen EC, Burgess AR, Siegel JH, Mason-Gonzalez S, Dischinger PC, Ho SM (1994) Pelvic fracture mechanism of injury in vehicular trauma patients. J Trauma 36:789–795
Guillemot H (1997) Etude biomécanique du basin en choc latéral automobile. Thèse de l’Ecole Nationale Supérieure d’Arts et Métiers. Paris (France)
Guille F, Cippola B, el Khader K, Lobel B (1998) Early endoscopy realignment for complete traumatic rupture of the posterior urethra—21 patients. Acta Urol Belg 66:5–58
Ihama Y, Fuke C, Miyazaki T (2007) A two-rider motorcycle accident injuries around groin area in both the driver and the passenger. Leg Med (Tokyo) 9:274–277
Koraitim MM, Marzouk ME, Atta MA, Orabi SS (1996) Risk factors and mechanism of urethral injury in pelvic fractures. Br J Urol 77:876–880
Kosola S, Salminen P, Laine T (2009) Heading for a fall—Moped and scooter accidents from 2002 to 2007. Scand J Surg 98:175–179
Masson C, Baqué P, Brunet C (2010) Biomechanical response of impacted bony pelvis: influence of the morphometry and bone density. Comput Methods Biomech Biomed Eng 13:641–646
Mathur R, Aggarwal G, Satsangi B, Khan F, Odiya S (2011) Prognosis of urethral strictures following pelvic fracture urethral distraction defects—a single centre study. Int J Surg 9:68–71
Paparel P, Badet L, Tayot O, Fessy MH, Bejui J, Martin X (2003) Mechanisms and frequency of urologic complications in 73 cases of unstable pelvic fractures. Prog Urol 13:54–59
Ruan JS, El-Jawahri R, Rouhana SW, Barbat S, Prasad P (2006) Analysis and evaluation of the biofidelity of the human body finite element model in lateral impact simulations according to ISO-TR9790 procedures. Stapp Car Crash J 50:491–507
Shiono H, Akane A, Matsubara K, Tanabe K, Takahashi S (1990) Identification of the driver in two-rider motorcycle accidents. Inguinal contusion-laceration as an indication of the driver. Am J Forensic Med Pathol 11:190–192
Snedeker JG, Muser MH, Walz FH (2003) Assessment of pelvis and upper leg injury risk in car-pedestrian collisions: comparison of accident statistics, impactor tests and a human body finite element model. Stapp Car Crash J 47:437–457
Tile M (1988) Pelvic ring fractures: should they be fixed. J Bone Joint Surg Br 70:1–12
Tropiano P, Thollon L, Arnoux PJ, Huang RC, Kayvantash K, Poitout DG et al (2004) Using a finite element model to evaluate human injuries application to the HUMOS model in whiplash situation. Spine (Phila Pa 1976) 15:1709–1716
Uhl JF, Park JS, Chung MS, Delmas V (2006) Three-dimensional reconstruction of urogenital tract from Visible Korean Human. Anat Rec A Discov Mol Cell Evol Biol 288:893–899
Venuti JM, Imielinska C, Molholt P (2004) New views of male pelvic anatomy: role of computer-generated 3D images. Clin Anat 17:261–271
Well D, Yang H, Houseni M, Iruvuri S, Alzeair S, Sansovini M et al (2007) Age-related structural and metabolic changes in the pelvic reproductive end organs. Semin Nucl Med 37:173–178
Yang KH, Hu J, White NA, King AI, Chou CC, Prasad P (2006) Development of numerical models for injury biomechanics research: a review of 50 years of publications in the Stapp Car Crash Conference. Stapp Car Crash J 50:429–490
Zhang SX, Heng PA, Liu ZJ, Tan LW, Qiu MG, Li QY et al (2004) The Chinese visible human datasets incorporate technical and imaging advances on earlier digital humans. J Anat 204:165–173
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Bréaud, J., Baqué, P., Loeffler, J. et al. Posterior urethral injuries associated with pelvic injuries in young adults: computerized finite element model creation and application to improve knowledge and prevention of these lesions. Surg Radiol Anat 34, 333–339 (2012). https://doi.org/10.1007/s00276-011-0900-0
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DOI: https://doi.org/10.1007/s00276-011-0900-0