The guideline committee has made the following recommendations for research.
How accurate is the first CT scan with contrast (trauma scan) for detecting bladder injuries in people with suspected bladder injuries after a traumatic incident?
Bladder injuries usually occur in people with high‑energy pelvic fractures after a traumatic incident. Currently people with suspected bladder injuries have a CT scan with intravenous contrast (a trauma scan) to diagnose non‑bladder injuries. People who do not have injuries needing urgent treatment may then either be given another CT scan or a fluoroscopic cystogram to check for bladder injury. People with injuries needing urgent treatment (for example, bleeding or a neurological injury) are taken to the resuscitation room after the initial CT scan (trauma scan). Once the person's condition is stabilised they are taken to either the CT or fluoroscopy suite for a retrograde cystogram to check for bladder injury. The guideline committee agreed that these strategies are accurate for the diagnosis of bladder injuries, but felt that there were advantages to a strategy that did not involve a second set of images. The guideline committee was interested in whether the first CT scan with intravenous contrast (trauma scan) could accurately diagnose bladder injuries.
In adults with closed pilon fractures, what method of fixation provides the best clinical and cost effectiveness outcomes as assessed by function and incidence of major complications at 2 years (stratified for timing of definitive surgery early [under 36 hours] versus later [over 36 hours])?
Pilon fractures involve a significant proportion of the weight‑bearing surface of the distal tibia. The damaged joint surface is vulnerable to degeneration. Therefore, the injury can lead to long‑term disability, most commonly arthritis with pain and stiffness. Surgery can improve outcomes, allowing reduction and fixation of the fracture and early movement of the ankle joint. However, it has a high incidence of serious complications, particularly related to the vulnerability of the soft tissues around the ankle. The potential for life‑changing adverse consequences of both the injury and its treatment is known, but the best management strategy to minimise these consequences is unclear.