11 September, 2014
Yesterday I saw a 2yo female a couple hours after she had suffered a straddle injury in daycare. She had fallen on a partition board that surrounded the play area and injured her groin.
This was the first time I triaged this type of injury, but I knew from reading provider notes that these injuries are usually minor and can result in discomfort with urination or bowel movements.
The mother wasn’t sure how much the injury hurt because she wasn’t crying or complaining when she picked her up from daycare, but later at home complained when she urinated. At day care she had a bowel movement without issue.
From uptodate I saw that straddle injuries can cause pelvic fractures, genitourethral damage, and kidney trauma. “Straddle injuries typically are unilateral and superficial. They involve the anterior portion of the genitalia in both boys and girls. Most straddle injuries in girls involve the mons, clitoral hood, and the labia minora anterior or lateral to the hymen. Straddle injury to the hymen or posterior fourchette is less common and should raise concern for sexual abuse.” *
On exam the patient was happy and smiling. Her outer genitalia had no sign of trauma. There was no bruising, swelling, or laceration visible. I did not do a thorough exam around the urethra, but when I went in with the provider later I watched how she did a proper exam, pulling the labia majora out and down, visualizing bilateral erythema in the tissue between the labia minora and the urethra. The patient’s UA contained large blood. The provider told me it can be normal to have blood in the urine after a straddle injury.
We recommended the patient sit in warm baths, especially for voiding if that was causing discomfort, and ice packs to the groin for pain relief. We advised her to return to clinic for any frank blood in the urine, difficulties urinating, or other concerns. She returned for follow up two days later and had decreased blood in the urine and decreased complaints of pain.
It was nice to have the opportunity to triage something different than the usual cough or diarrhea. That day I also got to see a kid with a foreign body in her foot for 2 months and another girl with a swollen eye from an unknown allergen. Good Times!
*uptodate “straddle injuries”