Bulbar Urethral Rupture with Sacral Fracture and Pubic Diastasis Managed by Orthopaedic Fixation and Conservative Catheterisation: A Case Report

Pelvic crush injuries after road traffic accidents seldom present with the combination of bulbar urethral rupture, comminuted sacral fracture and pubic symphysis diastasis to form a complex pattern mandating coordinated multidisciplinary care even in resourceconstrained environments. Hereby, the authors report a case of a 26-year-old male who presented to the Emergency Department after being crushed between a reversing truck and a wall with lower abdominal and inguinoscrotal trauma and acute urinary retention. Examination revealed perineal swelling with bilateral inguinal haematoma and tenderness. Initial urethral catheterisation attempts were unsuccessful. Contrast-Enhanced Computed Tomography (CECT) of the abdomen and pelvis with Three-Dimensional (3D) reconstruction revealed a bulbar urethra rupture, comminuted left sacral ala fracture extending to S5, and pubic symphysis diastasis, Tile Classification type C1. Definitive management included open reduction and internal fixation of the pubic diastasis with a pelvic reconstruction plate and screws, and sacral stabilisation with Iliosacral screw fixation. At the same time, the urethral injury was treated conservatively, with silicone Foley catheterisation. Postoperative recovery was uneventful, supported by structured physiotherapy and gradual mobilisation after an initial period of immobilisation. Timely surgical stabilisation of unstable pelvic fractures, combined with conservative catheter-based management of bulbar urethral rupture, can yield excellent early functional outcomes and may minimise long-term complications in patients.