Adverse effects of sodium-glucose cotransporter-2 inhibitors in patients with heart failure: a systematic review and meta-analysis.

Sodium-glucose cotransoporter-2 inhibitors (SGLT-2Is) improve prognosis in heart failure (HF) patients both with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). However, these drugs can have some side effects. To estimate the relative risk of side effects in HF patients treated with SGLT-2Is irrespective from left ventricular EF and setting (chronic and non-chronic HF). Five randomized controlled trials (RCTs) enrolling patients with HFrEF, 4 RCTs enrolling non-chronic HF, and 3 RCTs enrolling HFpEF were included. Among side effects, urinary infection, genital infection, acute kidney injury, diabetic ketoacidosis, hypoglycemia, hyperkalemia, hypokalemia, bone fractures, and amputations were considered in the analysis. Overall, 24,055 patients were included in the analysis: 9020 (38%) patients with HFrEF, 12,562 (52%) with HFpEF, and 2473 (10%) with non-chronic HF. There were no differences between SGLT-2Is and placebo in the risk to develop diabetic ketoacidosis, hypoglycemia, hyperkalemia, hypokalemia, bone fractures, and amputations. HFrEF patients treated with SGLT-2Is had a significant reduction of acute kidney injury (RR = 0.54 (95% CI 0.33-0.87), p = 0.011), whereas no differences have been reported in the HFpEF group (RR = 0.94 (95% CI 0.83-1.07), p = 0.348) and non-chronic HF setting (RR = 0.79 (95% CI 0.55-1.15), p = 0.214). A higher risk to develop genital infection (overall 2.57 (95% CI 1.82-3.63), p < 0.001) was found among patients treated with SGLT-2Is irrespective from EF (HFrEF: RR = 1.96 (95% CI 1.17-3.29), p = 0.011; HFpEF: RR = 3.04 (95% CI 1.88-4.90), p < 0.001). The risk to develop urinary infections was increased among SGLT-2I users in the overall population (RR = 1.13 (95% CI 1.00-1.28), p = 0.046) and in the HFpEF setting (RR = 1.19 (95% CI 1.02-1.38), p = 0.029), whereas no differences have been reported in HFrEF (RR = 1.05 (95% CI 0.81-1.36), p = 0.725) and in non-chronic HF setting (RR = 1.04 (95% CI 0.75-1.46), p = 0.806). SGLT-2Is increase the risk of urinary and genital infections in HF patients. In HFpEF patients, the treatment increases the risk of urinary infections compared to placebo, whereas SGLT-2Is reduce the risk of acute kidney disease in patients with HFrEF.

Sacubitril/valsartan and arrhythmic burden in patients with heart failure and reduced ejection fraction: a systematic review and meta-analysis.

The aim of this study was to assess whether angiotensin receptor/neprilysin inhibitor (ARNI) decreases ventricular arrhythmic burden compared to angiotensin-converting enzyme inhibitors or angiotensin receptor antagonist (ACE-I/ARB) treatment in chronic heart failure with reduced ejection fraction (HFrEF) patients. Further, we assessed if ARNI influenced the percentage of biventricular pacing. A systematic review of studies (both RCTs and observational studies) including HFrEF patients and those receiving ARNI after ACE-I/ARB treatment was conducted using Medline and Embase up to February 2023. Initial search found 617 articles. After duplicate removal and text check, 1 RCT and 3 non-RCTs with a total of 8837 patients were included in the final analysis. ARNI was associated with a significative reduction of ventricular arrhythmias both in RCT (RR 0.78 (95% CI 0.63-0.96); p = 0.02) and observational studies (RR 0.62; 95% CI 0.53-0.72; p < 0.001). Furthermore, in non-RCTs, ARNI also reduced sustained (RR 0.36 (95% CI 0.2-0.63); p < 0.001), non-sustained VT (RR 0.67 (95% CI 0.57-0.80; p = 0.007), ICD shock (RR 0.24 (95% CI 0.12-0.48; p < 0.001), and increased biventricular pacing (2.96% (95% CI 2.25-3.67), p < 0.001). In patients with chronic HFrEF, switching from ACE-I/ARB to ARNI treatment was associated with a consistent reduction of ventricular arrhythmic burden. This association could be related to a direct pharmacological effect of ARNI on cardiac remodeling.Trial registration: CRD42021257977.

Ex vivo biomechanical evaluation of 2.4 mm LCP plate rod constructs versus 2.7 mm LCP applied to the feline tibia.

OBJECTIVE: To compare the stiffness and strength of three plate and rod fixation constructs applied to a feline tibial gap model. STUDY DESIGN: Ex vivo study. SAMPLE POPULATION: Thirty-three unpaired tibiae obtained from skeletally mature cats. METHODS: The tibiae were randomly divided into three groups. The following implants were then applied to the feline tibiae prior to the creation of a 10 mm diaphyseal gap. Group 1: 2.4 mm locking compression plate (LCP) and 1.0 mm intramedullary pin (IMP). Group 2: 2.4 mm LCP and 1.6 mm IMP. Group 3: 2.7 mm LCP. Subsequently, each specimen was tested for torsion, axial compression, and axial load until construct failure. Student's t-tests were used to compare the torsional and axial stiffness, yield load, and maximum axial force. RESULTS: Group 2 had higher axial stiffness than group 3 (p = .013). Group 1 showed a lower maximum axial force and yield point than groups 2 and 3 (p < .01; p < .05, respectively). There were no among-group differences in torsional stiffness. CONCLUSION: Constructs with a 2.4 mm LCP and 1.6 mm IMP provided the strongest and most rigid constructs in a feline tibia gap model. CLINICAL SIGNIFICANCE: A plate-rod construct combining a 2.4 mm LCP and a 1.6 mm IMP is appropriate for achieving high implant stiffness and resisting maximum axial force in treatment of tibial fractures in cats.

In Planta Sporulation of Frankia spp. as a Determinant of Alder-Symbiont Interactions.

The Alnus genus forms symbiosis with the actinobacteria Frankia spp. and ectomycorrhizal fungi. Two types of Frankia lineages can be distinguished based on their ability to sporulate in planta Spore-positive (Sp+) strains are predominant on Alnus incana and Alnus viridis in highlands, while spore-negative (Sp-) strains are mainly associated with Alnus glutinosa in lowlands. Here, we investigated whether the Sp+ predominance in nodules is due to host selection of certain Frankia genotypes from soil communities or the result of the ecological history of the alder stand soil, as well as the effect of the sporulation genotype on the ectomycorrhizal (ECM) communities. Trapping experiments were conducted using A. glutinosa, A. incana, and A. viridis plantlets on 6 soils, differing in the alder species and the frequency of Sp+ nodules in the field. Higher diversity of Frankia spp. and variation in Sp+ frequencies were observed in the trapping than in the fields. Both indigenous and trapping species shape Frankia community structure in trapped nodules. Nodulation impediments were observed under several trapping conditions in Sp+ soils, supporting a narrower host range of Sp+ Frankia species. A. incana and A. viridis were able to associate equally with compatible Sp+ and Sp- strains in the greenhouse. Additionally, no host shift was observed for Alnus-specific ECM, and the sporulation genotype of Frankia spp. defined the ECM communities on the host roots. The symbiotic association is likely determined by the host range, the soil history, and the type of in plantaFrankia species. These results provide an insight into the biogeographical drivers of alder symbionts in the Holarctic region.IMPORTANCE Most Frankia-actinorhiza plant symbioses are capable of high rates of nitrogen fixation comparable to those found on legumes. Yet, our understanding of the ecology and distribution of Frankia spp. is still very limited. Several studies have focused on the distribution patterns of Frankia spp., demonstrating a combination of host and pedoclimatic parameters in their biogeography. However, very few have considered the in planta sporulation form of the strain, although it is a unique feature among all symbiotic plant-associated microbes. Compared with Sp- Frankia strains, Sp+ strains would be obligate symbionts that are highly dependent on the presence of a compatible host species and with lower efficiency in nitrogen fixation. Understanding the biogeographical drivers of Sp+ Frankia strains might help elucidate the ecological role of in planta sporulation and the extent to which this trait mediates host-partner interactions in the alder-Frankia-ECM fungal symbiosis.

Radiosurgery-assisted gingival displacement: a proof of concept technique to enhance the efficiency of intraoral digital impression.

Nowadays, an increasing number of dentists are using intraoral scanners (IOS) in their daily practice as an alternative to conventional impression taking. One of the main concerns is related to the capability of scanning the subgingival anatomy of the die, usually very challenging due to the limited operative field and the presence of oral fluids. The radiosurgery assisted gingival displacement technique (RAGD) may enhance the intraoral optical scanning of the finish line and neighbor tooth anatomy. The contour of the interim prosthesis is used to drive the tip of radiosurgery electrode along the tooth surface and open selectively the gingival crevice with a prosthetically-driven and minimally invasive approach. The clinical implication of this technique is related to increasing the efficiency and accuracy of the digital impression technique in the critical zone of the prosthetic shoulder.

[Arthroscopic-assisted stabilization of medial shoulder instability in a Miniature Poodle]. / Arthroskopisch-assistierte Stabilisation einer medialen Schulterinstabilität bei einem Zwergpudel.

INTRODUCTION: A 12-year old female miniature Poodle was presented because of a 4/4 right fore-limb lameness. The orthopedic examination demonstrated pain at palpation of the right shoulder and an abduction angle of 55 °. MRI examination confirmed injuries consistent with a traumatic medial shoulder instability with no evidence of shoulder dysplasia. A partial rupture of the subscapularis tendon and complete detachment of the cranial gleno- humeral ligament were confirmed with arthroscopy. The joint was successfully stabilized using an arthroscopic assisted prosthetic suture.

Surgical treatment of a proximal diaphyseal tibial deformity associated with partial caudal and cranial cruciate ligament deficiency and patella baja.

INTRODUCTION: Caudal cruciate ligament injury can be a complication following tibial plateau leveling osteotomy (TPLO) (Slocum und Slocum, 1993) especially if the post-operative Tibial Plateau Angle (TPA) is less than 5 degree. We describe a case of negative TPA associated with partial cranial and caudal ligament rupture treated with a center of rotation of angulation (CORA) based cranial tibial opening wedge osteotomy and tibial tuberosity transposition. A 13 kg, mixed breed dog was presented for right pelvic limb lameness. Radiographically a bilateral patella baja and a malformed tibia tuberosity along with a bilateral TPA of -8 degree were detected. Arthroscopically a partial rupture of the cranial and caudal cruciate ligaments were found. A cranial tibial opening wedge osteotomy of 23 degree and a fibular ostectomy were performed. The osteotomy was fixed with a 8 holes ALPS 9 (KYON, Switzerland) and a 3-holes 2.0mm UniLock plate (Synthes, Switzerland). Then a proximal tibial tuberosity transposition of 10mm was performed and fixed with a pin and tension band construct. The postoperative TPA was 15 degree. The radiographic controls at 6, 10 weeks, 6 months and 1 year after surgery revealed an unchanged position of the implants and progressive healing of the osteotomies. At the 6 and 12 months recheck evaluation the dog had no evidence of lameness or stifle pain and radiographs revealed complete healing of the osteotomy site and no implant failure. The diaphyseal CORA based osteotomy allowed accurate correction of a proximal tibial deformity associated with negative TPA.

Integrin α1ß1 protects against signs of post-traumatic osteoarthritis in the female murine knee partially via regulation of epidermal growth factor receptor signalling.

OBJECTIVE: To investigate the role of integrin α1ß1 in the progression of post-traumatic osteoarthritis (PTOA), and elucidate the contribution of epidermal growth factor receptor (EGFR) signalling to the mechanism by which integrin α1ß1 might control PTOA. We hypothesised that integrin α1ß1 plays a protective role in the course of PTOA and that the effect of PTOA (e.g., synovitis, loss of cartilage and growth of osteophytes) would be exacerbated in mice lacking integrin α1ß1 at every time point post destabilisation of medial meniscus (DMM). METHODS: DMM or sham surgery was performed on integrin α1-null and wild type (WT) mice and the progression of PTOA analysed at 2, 4, 8 and 12 weeks post-surgery (PS) using micro-computed tomography (microCT), histology, and immunohistochemistry. In addition, the effects of EGFR blockade were examined by treating the mice with the EGFR inhibitor erlotinib. RESULTS: Integrin α1-null female, but not male, mice showed earlier cartilage degradation post DMM surgery compared to WT controls. Furthermore, erlotinib treatment resulted in significantly less cartilage damage in integrin α1-null but not WT mice. Independent of genotype, erlotinib treatment significantly mitigated the effects of PTOA on many tissues of female mice including meniscal and fabella bone volume, subchondral bone thickness and density and cartilage degradation. In contrast, reduced EGFR signalling had little effect on signs of PTOA in male mice. CONCLUSION: Integrin α1ß1 protects against PTOA-induced cartilage degradation in female mice partially via the reduction of EGFR signalling. Furthermore, reduction of EGFR signalling protects against the development of PTOA in female, but not male mice.

Integrin α1ß1 differentially regulates cytokine-mediated responses in chondrocytes.

OBJECTIVE: To elucidate the role of integrin α1ß1 in chondrocyte responses to inflammatory interleukin-1α (IL-1) and anabolic transforming growth factor-ß1 (TGF-ß1) in the knee. METHODS: Intracellular calcium transient responses to IL-1 and TGF-ß1 were measured in wild type and integrin α1-null chondrocytes using real time ex vivo confocal microscopy, and immunohistochemistry was performed to analyze TGF-ß1-mediated activation of Smad2/3 in tibial and femoral chondrocytes. RESULTS: Loss of integrin α1ß1 reduces intracellular calcium transient response to IL-1, while it enhances chondrocyte responses to TGF-ß1 as measured by intracellular calcium transients and activation of downstream Smad2/3. CONCLUSIONS: Integrin α1ß1 plays a vital role in mediating chondrocyte responses to two contrasting factors that are critical players in the onset and progression of osteoarthritis - inflammatory IL-1 and anabolic TGF-ß. Further investigation into the molecular mechanisms by which integrin α1ß1 mediates these responses will be an important next step in understanding the influence of increased expression of integrin α1ß1 during the early stages of osteoarthritis on disease progression.

High-resolution melt analysis does not reveal mutagenic risk in sexed sperm and in vitro-derived bovine embryos.

The objectives of the present work were to verify whether simultaneous exposure to Hoechst 33342 and UV irradiation during sorting by flow cytometry may induce gene point mutations in bovine sperm and to assess whether the dye incorporated in the sperm may imply a mutagenic effect during the embryonic development. To this aim, high-resolution melt analysis (HRMA) was used to discriminate variations of single nucleotides in sexed vs. non-sexed control samples. Three batches of sorted and non-sorted commercial semen of seven bulls (42 samples) were subjected to HRMA. A set of 139 genes located on all the chromosomes was selected, and 407 regions of the genome covering a total of 83 907 bases were analyzed. Thereafter, sperm of one sexed and one non-sexed batch of each bull was used in in vitro fertilization, and the derived embryos were analyzed (n = 560). One hundred and thirty-three regions of the bovine genome, located in 40 genes, were screened for a total coverage of 23 397 bases. The comparison between the frequencies of variations, with respect to the sequences deposited, observed in the sexed and non-sexed sperm (843 vs. 770) and embryos (246 vs. 212) showed no significant differences (P > 0.05), as measured by chi-square tests. It can be concluded that staining with Hoechst 33342 and exposure to UV during sorting does not lead to significant changes in the frequencies of variants in the commercial sexed semen and in embryos produced in vitro with the same treated sperm.

Aldosterone deficiency prevents high-fat-feeding-induced hyperglycaemia and adipocyte dysfunction in mice.

AIMS/HYPOTHESIS: Obesity is associated with aldosterone excess, hypertension and the metabolic syndrome, but the relative contribution of aldosterone to obesity-related complications is debated. We previously demonstrated that aldosterone impairs insulin secretion, and that genetic aldosterone deficiency increases glucose-stimulated insulin secretion in vivo. We hypothesised that elimination of endogenous aldosterone would prevent obesity-induced insulin resistance and hyperglycaemia. METHODS: Wild-type and aldosterone synthase-deficient (As (-/-)) mice were fed a high-fat (HF) or normal chow diet for 12 weeks. We assessed insulin sensitivity and insulin secretion using clamp methodology and circulating plasma adipokines, and examined adipose tissue via histology. RESULTS: HF diet induced weight gain similarly in the two groups, but As (-/-) mice were protected from blood glucose elevation. HF diet impaired insulin sensitivity similarly in As (-/-) and wild-type mice, assessed by hyperinsulinaemic-euglycaemic clamps. Fasting and glucose-stimulated insulin were higher in HF-fed As (-/-) mice than in wild-type controls. Although there was no difference in insulin sensitivity during HF feeding in As (-/-) mice compared with wild-type controls, fat mass, adipocyte size and adiponectin increased, while adipose macrophage infiltration decreased. HF feeding significantly increased hepatic steatosis and triacylglycerol content in wild-type mice, which was attenuated in aldosterone-deficient mice. CONCLUSIONS/INTERPRETATION: These studies demonstrate that obesity induces insulin resistance independently of aldosterone and adipose tissue inflammation, and suggest a novel role for aldosterone in promoting obesity-induced beta cell dysfunction, hepatic steatosis and adipose tissue inflammation.

Treatment of traumatic cranial fracture with sonic activated polymer pins and plates resorbable implants in a dog.

INTRODUCTION: The case report describes the use of ultrasound-activated resorbable implants for surgical repair of comminuted cranial fractures in a 10 years old medium sized mix-breed dog being injured from a horse kick.

INTRODUCTION: Ce rapport de cas décrit l'utilisation d'implants résorbables activés par ultrasons pour la réparation chirurgicale de fractures crâniennes comminutives chez un chien de race moyenne âgé de 10 ans, blessé par un coup de pied de cheval.

Unusual anchor pins placement and protocol deviations during computer-based implant placement in a patient with severe mandibular bone atrophy. A case report.

The aim of the study was to describe an unusual method to stabilize the surgical template during the treatment of a severely resorbed edentulous mandible by means of computer-guided implant surgery. Pre-operative computer-based planning revealed the difficulty to stabilize the surgical template in a 67-year-old healthy woman. A deviation of the original NobelGuide™ protocol was performed to ensure the stability of the surgical template: four anchor pins were used to stabilize the surgical template, two in the buccal side of the anterior template and two unusual pins were placed in the lingual site. Four straight TiUnite® Nobel Biocare™ implants were then placed, according to a modified All-on-4™ concept procedure, to avoid graft procedures and to reduce the cumulative chair-side treatment time and costs. A temporary restoration was placed immediately after implant placement. Three months later a definitive, full acrylic restoration was delivered.

Current surgical options for articular cartilage repair.

The articular cartilage lesions represent one of the major unsolved problems in the orthopaedic surgery. This is because articular cartilage has a limited capacity of self-repair following trauma. The aim of this study is to review the different surgical options for articular cartilage repair. They can be divided into three groups: techniques without transplant of cells or tissues; techniques based on the transplantation of tissues; the tissue engineering techniques.The first group includes the joint debridement and the techniques based on the bone marrow-stimulation principle.The second group includes the transplantation of periosteum and the transplantation of autologous or allogeneic osteochondral plugs. The tissue engineering techniques could be further divided as follows: methods based on the transplantation of cells either in solution, or in the form of microspheres, or carried on a biocompatible scaffold; the transplant of cartilage fragments; the cell-free techniques, based on the use of an acellular scaffold, able to entrap the reparative cells recruited from the host tissue and to guide their differentiation toward a chondral phenotype.In this work we present various options for the treatment of chondral or osteochondral lesions. Today, however, due to the lack of comparative studies, it is not always possible to define the best treatment choice for the different cartilage pathologies.

Evaluation of vascular trauma after tibial plateau levelling osteotomy with or without gauze protection. A cadaveric angiographic study.

OBJECTIVE: To evaluate the integrity of the cranial tibial artery after performing the tibial plateau levelling osteotomy (TPLO) with or without soft tissue dissection and protection with gauze sponges. STUDY DESIGN: Experimental cadaveric study. ANIMALS: Ten dogs weighing 28 to 35 kg. METHODS: Ten pairs of normal pelvic limbs were divided randomly into two groups in which a TPLO was performed with or without soft tissue protection with gauze sponges respectively. Angiography was used to evaluate the integrity of the cranial tibial artery after TPLO in each group. Contrast angiography was performed for each group: 1) before TPLO [Control]; 2) after TPLO [Osteotomy]; and 3) after intentional laceration of the cranial tibial artery [Arteriotomy]. A 'yes or no' was used to score contrast extravasation. The area of extravasated contrast was also calculated on the radiographs. A Mann-Whitney test and an ANOVA with repeated measures were completed to assess the score and the area, respectively, for each of the surgical treatments (Control, Osteotomy, and Arteriotomy) between the conditions of dissection with respect to the cranial tibial artery. A value of p <0.05 was considered significant. RESULTS: The differences between the two groups (with and without protection) for scores and areas of leakage were not significant (p >0.05). However, significant differences were noted between Control and Arteriotomy (p <0.01) and Osteotomy and Arteriotomy (p <0.01), but not between Control and Osteotomy (p >0.05). CONCLUSIONS AND CLINICAL RELEVANCE: A TPLO without protection of the cranial tibial artery can be performed without increased risk of arterial trauma.

A review of extra-articular prosthetic stabilization of the cranial cruciate ligament-deficient stifle.

Extra-articular prosthetic stabilization techniques have been used as a method of stabilization of the cranial cruciate ligament (CrCL)-deficient stifle for decades. During extra-articular prosthetic stabilization, the prosthesis is anchored to the femur and tibia, and tensioned in the attempt to resolve femorotibial instability. The position of the anchor points of the prosthesis is crucial for restoring a normal range of joint motion and mitigating alterations in prosthesis tension during motion. Recently developed techniques offer several innovations with potential advantages such as bone-to-bone fixation, prosthetic materials with better mechanical properties, and improved isometry of the anchor points. Whether these innovations provide clinically superior results to the traditional techniques such as lateral circumfabellar-tibial suture techniques has yet to be determined.

The extraction of microplastics from sediments: An overview of existing methods and the proposal of a new and green alternative.

Microplastics (MPs) contamination is an existing and concerning environmental issue. Plastic particles have been observed worldwide in every natural matrix, with water environments being the final sink of dispersed MPs. Microplastic distribution in water ecosystems varies as a function of multiple factors, including polymer properties (e.g., density and wettability) and environmental conditions (e.g., water currents and temperature). Because of the tendency of MPs to settle, sediment is known to be one of the most impacted environmental matrices. Despite the increasing awareness of their diffusion in sediments, a proper quantification of dispersed particles is still difficult, due to the lack of standard protocols, which avoid a proper comparison of different sites. This hampers the current knowledge on environmental implications and toxicological effects of MPs in sediments. In this work, we examined 49 studies carried out from 2004 to 2020 to describe the different extraction methods applied, and to highlight pros and cons, with the aim of evaluating the more promising protocols. Therefore, we evaluated each proposed method by considering precision, reproducibility, economic viability and greenness (in term of used reagents). Finally, we proposed a valid alternative procedure in term of reliability and costs, which can attract increasing interest for future studies.

Evaluation of artificial sweat in athletes with spinal cord injuries.

Athletes with spinal cord injury often experience high heat storage due to reduced sweating capacity below the spinal injury. Spray bottle (SB) may be used to apply mist for evaporative cooling during breaks in competitions. This study examined the efficacy of SB during rest breaks. Seven participants, four female and three males, (mean +/- SD age 24 +/- 4.1 year, weight 56.2 +/- 7.0 kg, upper-body VO(2) peak 2.4 +/- 0.6 l/min) volunteered for the study. Participants were paraplegic athletes (T3-T12/L1) with both complete and incomplete lesions. Participants arm-cranked using a ramp protocol in an environment of 21 +/- 1.5 degrees C and 55 +/- 3% rh once using a SB during 1-min rest between 7-min stages of increasing intensity and once without the SB (CON). Mean total work was similar (p = 0.86) for the SB and CON (2495.7 +/- 914.6 vs. 2407.1 +/- 982.3 kJ, respectively). Likewise, the mean work times were similar between trials (27 +/- 6 and 26 +/- 7 min for SB and CON, respectively). Furthermore, there were no significant differences detected between trials for skin temperature, rectal temperature, esophageal temperature (p > 0.05). There were no statistically significant differences detected between trials for RPE (p > 0.05). In conclusion, the application of artificial sweat via SB was ineffective in attenuating the onset of uncompensable heat strain during high-intensity arm exercise in a comfortable environment.

Torsion of the urinary bladder after pelvic trauma and surgical fixation.

Urinary bladder torsion in a dog was successfully treated with reduction of the torsion and cystopexy. Urinary bladder torsion is a rare occurrence in dogs and has only been reported once previously. In the previous report, the bladder torsion was iatrogenic. This brief communication describes a case of bladder torsion and subtotal necrosis following reduction and stabilisation of pelvic fractures sustained during a road traffic accident. Proposed aetiology, diagnosis, treatment and postoperative management are discussed.