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In straddle injury, the patient has pain, swelling, contusion, and hematoma of the perineum or scrotum following direct blunt trauma. This injury is commonly caused by a fall onto a bicycle frame top tube, playground equipment, or a toilet seat. Swelling can be severe enough to interfere with urination. Scrotal contents can also be contused or crushed with this injury.
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Management and Disposition
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Treatment is supportive and includes cold packs, elevation, rest, and analgesics. If unable to void, catheterize the patient, but first obtain a retrograde urethrogram if concomitant urethral injury is suspected.
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Perineal laceration can be obscured by swelling if a careful examination is not performed.
Pelvic radiographs should be obtained in all perineal injuries.
Men and women are at high risk for urethral injuries with this type of injury.
Straddle injury is differentiated from abuse with a good history from a reliable caregiver that matches the injury.
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