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.
Management and Disposition
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.
Straddle Injury. Marked ecchymosis, swelling, and contusion of the perineum in an adolescent girl. Examination under anesthesia was required to determine the extent of this patient’s injuries. (Photo contributor: Lawrence B. Stack, MD.)
Straddle Injury. Contusion of the scrotum and lower abdomen in a young boy consistent with a straddle injury. (Photo contributor: David W. Munter, MD.)
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.
Straddle Injury. This unfortunate patient suffered a vaginal tear as a result of slipping forward off the seat of her bicycle and landing on its top tube. (Photo contributor: R. Jason Thurman, MD.)