1
|
Olszewski NP, Sliepka J, Bigham JJ, Firoozabadi R, Githens MJ, Routt MC, Kleweno CP. Factors Associated With Infection in Patients With Combined Pelvic Ring and Bladder Injuries. J Orthop Trauma 2024; 38:459-465. [PMID: 39150296 DOI: 10.1097/bot.0000000000002846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVES To identify the infection rate in patients with combined pelvic ring and bladder injuries. Secondary aims included identifying treatment and injury factors associated with infection. METHODS DESIGN Retrospective review. SETTING Single Level I Tertiary Academic Center. PATIENTS SELECTION CRITERIA All patients over a 12-year period with combined pelvic ring and bladder injuries were evaluated. Exclusion criteria were nonoperative management of the pelvic ring, isolated posterior fixation, and follow-up <90 days. OUTCOME MEASURE AND COMPARISONS Primary outcome measured was deep infection of the anterior pelvis requiring surgical irrigation and debridement. RESULTS In total, 106 patients with anterior stabilization of the pelvis in the setting of a bladder injury were included. Seven patients (6.6%) developed a deep infection and required surgical debridement within 90 days. Patients undergoing open reduction and internal fixation with plating of the anterior pelvis and acute concomitant bladder repair had an infection rate of 2.2% (1/43). Patients undergoing closed reduction and anterior fixation with either external fixation or percutaneous rami screw after bladder repair had an infection rate of 17.6% (3/17). There was a higher infection rate among patients with combined intraperitoneal (IP) and extraperitoneal (EP) bladder injuries (23%) when compared with those with isolated EP (3.8%) or IP (9.1%) bladder injuries (P = 0.029). CONCLUSIONS Acute open reduction and internal fixation of the anterior pelvis in patients with combined pelvic ring and bladder injuries has a low infection rate. Patients with combined IP and EP bladder injuries are at increased risk of infection compared with those with isolated IP and EP injuries. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
| | - Joseph Sliepka
- Department of Orthopaedics and Sports Medicine, University of Washington, Harborview Medical Center, Seattle, WA; and
| | - Joseph J Bigham
- Department of Orthopaedics and Sports Medicine, University of Washington, Harborview Medical Center, Seattle, WA; and
| | - Reza Firoozabadi
- Department of Orthopaedics and Sports Medicine, University of Washington, Harborview Medical Center, Seattle, WA; and
| | - Michael J Githens
- Department of Orthopaedics and Sports Medicine, University of Washington, Harborview Medical Center, Seattle, WA; and
| | - Milton Chip Routt
- Department of Orthopedic Surgery, UT Health Houston, McGovern Medical School, Houston, TX
| | - Conor P Kleweno
- Department of Orthopaedics and Sports Medicine, University of Washington, Harborview Medical Center, Seattle, WA; and
| |
Collapse
|
2
|
Baker JE, Ladhani HA, McCall C, Horwood CR, Werner NL, Platnick B, Cothren Burlew C. Factors Associated With Pelvic Infection After Pre-Peritoneal Pelvic Packing for Hemodynamically Unstable Pelvic Fractures. Surg Infect (Larchmt) 2024; 25:399-406. [PMID: 38752886 DOI: 10.1089/sur.2023.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
Background: Preperitoneal pelvic packing (PPP) and external fixation has led to improved mortality after devastating pelvic trauma. However, there is limited literature on infection after this intervention. We aim to study the risk factors associated with pelvic infection after PPP. Patients and Methods: A retrospective review of patients who underwent PPP at a single level 1 trauma center was performed. Results: Over the 18-year study period, 222 patients were identified. Twenty-three percent of patients had an open fracture. Pelvic angiography was performed in 24% of patients with 16% requiring angioembolization (AE). The average time to packing removal was two (one to two days) days, although 10% of patients had their pelvis re-packed. Overall infection rate was 14% (n = 31); if pelvic re-packing was performed, the infection rate increased to 45%. Twenty-two of the patients with an infection required additional procedures for their infection, and ultimately hardware removal occurred in eight patients. On univariable analysis, patients with pelvic infections had more open fractures (55% vs. 17%; p < 0.01), underwent AE more frequently (29% vs. 14%; p = 0.04), were more likely to undergo repacking (32% vs. 6%; p < 0.01), and had packing in place for longer (2 [1,2] vs. 2 [2,3]; p = 0.01). On logistic multivariable regression analysis, open fracture (odds ratio [OR], 5.8; 95% confidence interval [CI], 2.4-14.1) and pelvic re-packing (OR, 4.7; 95% CI, 1.2-18.5) were independent risk factors for pelvic infection. Conclusions: Pelvic infection after PPP is a serious complication independently associated with open fracture and re-packing of the pelvis. Re-intervention was required in most patients with infection.
Collapse
Affiliation(s)
- Jennifer E Baker
- Department of Surgery, Denver Health Medical Center, Denver, Colorado, USA
- Division of Gastrointestinal, Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Husayn A Ladhani
- Department of Surgery, Denver Health Medical Center, Denver, Colorado, USA
- Division of Gastrointestinal, Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Caitlyn McCall
- Department of Surgery, Denver Health Medical Center, Denver, Colorado, USA
- Division of Gastrointestinal, Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Chelsea R Horwood
- Department of Surgery, Denver Health Medical Center, Denver, Colorado, USA
- Division of Gastrointestinal, Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Nicole L Werner
- Division of Acute Care and Regional General Surgery, Department of Surgery, University of Wisconsin School of Medicine, Madison, Wisconsin, USA
| | - Barry Platnick
- Department of Surgery, Denver Health Medical Center, Denver, Colorado, USA
| | - Clay Cothren Burlew
- Division of Gastrointestinal, Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| |
Collapse
|
3
|
Singh A, Kotzur T, Koslosky E, Gonuguntla R, Canseco L, Momtaz D, Seifi A, Martin C. Angioembolization Has Similar Efficacy and Lower Total Charges than Preperitoneal Pelvic Packing in Patients With Pelvic Ring or Acetabulum Fractures. J Orthop Trauma 2024; 38:254-258. [PMID: 38378177 DOI: 10.1097/bot.0000000000002789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVES To compare cost, hospital-related outcomes, and mortality between angioembolization (AE) and preperitoneal pelvic packing (PPP) in the setting of pelvic ring or acetabulum fractures. METHODS . DESIGN Retrospective database review. SETTING National Inpatient Sample, years 2016-2020. PATIENT SELECTION CRITERIA Hospitalized adult patients who underwent AE or PPP in the setting of a pelvic ring or acetabulum fracture. OUTCOME MEASURES AND COMPARISONS Mortality and hospital-associated outcomes, including total charges, following AE versus PPP in the setting of pelvic ring or acetabulum fractures. RESULTS A total of 3780 patients, 3620 undergoing AE and 160 undergoing PPP, were included. No significant differences in mortality, length of stay, time to procedure, or discharge disposition were found ( P > 0.05); however, PPP was associated with significantly greater charges than AE ( P = 0.04). Patients who underwent AE had a mean total charge of $250,062.88 while those undergoing PPP had a mean total charge of $369,137.16. CONCLUSIONS Despite equivalent clinical efficacy in terms of mortality and hospital-related outcomes, PPP was associated with significantly greater charges than AE in the setting of pelvic ring or acetabulum fractures. This data information can inform clinical management of these patients and assist trauma centers in resource allocation. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Ali Seifi
- Department of Neurosurgery, UT Health San Antonio, San Antonio, TX
| | | |
Collapse
|
4
|
Altamirano-Cruz MA, Velarde JE, Valderrama-Molina CO, Azi M, Belangero WD, Bidolegui F, Carabelli GS, Gómez A, Pires RE, Xicará JA, Giordano V. Availability and use of resources for emergency fracture care of pelvic trauma associated with haemorrhagic shock in Latin America: A cross-sectional study. Injury 2023; 54 Suppl 6:110733. [PMID: 38143149 DOI: 10.1016/j.injury.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/14/2023] [Accepted: 04/12/2023] [Indexed: 12/26/2023]
Abstract
Determining the true availability of resources and understanding the level of training of surgeons involved in the treatment of patients with pelvic fractures and haemorrhagic shock is critical. In the herein study, the availability of technical, technological, and human resources for the care of this injury in Latin America region was analysed, and the preferences of orthopaedic trauma surgeons when performing interventions for the diagnosis and treatment of patients with pelvic trauma and associated haemorrhagic shock was described. A cross sectional web-based survey containing questions on knowledge, attitudes, and practices with respect to imaging resources, emergency pelvic stabilization methods, and interventions used for bleeding control was sent to 948 Latin America orthopaedic trauma surgeons treating pelvic fractures in the emergency department. Differences between regional clusters, level of training, type of hospital, and pelvic surgery volume were assessed. 368 responses were obtained, with 37.5% of respondents reporting formal training in pelvic surgery and 36.0% having available protocol for managing these patients. The most frequently used interventions were the supra-acetabular pelvic external fixator and pelvic packing. Limited hospital and imaging resources are available for the care of patients with pelvic trauma and associated haemorrhagic shock throughout Latin America. In addition, the training of orthopaedic trauma surgeons dealing with this type of injury and the volume of pelvic surgeries per year is heterogeneous. It should be urgently considered to develop management protocols adapted to Latin America according to the availability of resources, as well as to promote training in this severe life-threatening traumatic condition.
Collapse
Affiliation(s)
| | | | | | - Matheus Azi
- Departamento de Ortopedia, Hospital Manoel Victorino, Secretaria Estadual de Saúde do Estado da Bahia, Salvador, Brazil
| | - William Dias Belangero
- Departamento de Ortopedia, Reumatologia e Traumatologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas UNICAMP, Campinas, SP, Brazil
| | - Fernando Bidolegui
- Servicio de Ortopedia y Traumatologia, Hospital Sirio-Libanes, ECICARO, Buenos Aires, Argentina
| | - Guido Sebastián Carabelli
- Sector de Trauma, Instituto de Ortopedia y Traumatología "Prof. Dr. Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Amparo Gómez
- Servicio Ortopedia, Hospital Universitario de la Samaritana, Bogota, Colombia
| | - Robinson Esteves Pires
- Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - José Arturo Xicará
- Centro Universitario de Occidente, Universidad de San Carlos de Guatemala, Quetzaltenango, Guatemala; Cruz Roja Guatemalteca, Delegación Quetzaltenango, Quetzaltenango, Guatemala
| | - Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, RJ, Brazil; Clínica São Vicente, Rede D'or São Luiz, Rio de Janeiro, RJ, Brazil
| |
Collapse
|
5
|
Freigang V, Walter N, Rupp M, Riedl M, Alt V, Baumann F. Treatment of Fracture-Related Infection after Pelvic Fracture. J Clin Med 2023; 12:6221. [PMID: 37834865 PMCID: PMC10573264 DOI: 10.3390/jcm12196221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The management of pelvic fractures is a significant challenge. Surgical site infection can result in the need for revision surgery, cause functional impairment, and lead to a prolonged length of stay and increased treatment costs. Although reports on fracture-related infection (FRI) after pelvic fracture fixation are sparsely reported in the literature, it is a serious complication. This study analysed patients with FRIs after pelvic fracture regarding patient characteristics, treatment strategies, and an evaluation of risk factors for FRI. METHODS In this retrospective single-centre study, FRI was diagnosed based on clinical symptoms of infection and a positive culture of a bacterial infection. Depending on the severity and acuteness of the infection, osseous stabilization was restored either via implant retention (stable implant, no osteolysis), exchange (loose implant or bony defect), or external fixation (recurrence of infection after prior implant retaining revision). Healing of infection was defined as no sign of recurring infection upon clinical, radiological, and laboratory examination in the last follow-up visit. RESULTS The FRI rate in our patient population was 7.5% (24/316). In 8/24 patients, the FRI occurred within the first three weeks after initial surgery (early) and 16/24 presented with a late onset of symptoms of FRI. A strategy of debridement, antibiotics, and implant retention (DAIR) was successful in 9/24 patients with FRI after pelvic fracture. A total of 10 patients required an exchange of osteo-synthetic implants, whereof three were exchanged to an external fixator. In five patients, we removed the implant because the fracture had already consolidated at the time of revision for infection. A total of 17/24 patients had a poly-microbial infection after a pelvic fracture and 3/24 patients died from post-traumatic multi-organ failure within the first 6 months after trauma. There were no cases of persistent infection within the remaining 21 patients. CONCLUSIONS Although poly-microbial infection is common in FRI after pelvic fracture, the recurrence rate of infection is relatively low. A complex pelvic trauma with significant soft tissue injury is a risk factor for recurrent infection and multiple revisions. A strategy of DAIR can be successful in patients with a stable implant. In cases with recurrent infection or an unstable fracture site, the exchange of implants should be considered.
Collapse
Affiliation(s)
- Viola Freigang
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
- Faculty of Interdisciplinary Studies, Landshut University of Applied Sciences, Am Lurzenhof 1, 84036 Landshut, Germany
| | - Nike Walter
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Moritz Riedl
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Florian Baumann
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| |
Collapse
|
6
|
Lai CY, Lai PJ, Tseng IC, Su CY, Hsu YH, Chou YC, Yu YH. Morel-Lavallee lesions and number of surgeries for associated injuries predict surgical site infection risk following pelvic ring injury osteosynthesis. Sci Rep 2023; 13:8208. [PMID: 37217581 DOI: 10.1038/s41598-023-35488-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 05/18/2023] [Indexed: 05/24/2023] Open
Abstract
We examined the incidence and causative factors of surgical site infection (SSI) following osteosynthesis for pelvic ring injury by reviewing the data of 97 consecutive patients with pelvic ring injuries treated between 2014 and 2019. Osteosyntheses, including internal or external skeletal fixation with plates or screws, were performed based on fracture type and patient's condition. Fractures were treated surgically, with a 36 months minimum follow-up period. Eight (8.2%) patients experienced SSI. The most common causative pathogen was Staphylococcus aureus. Patients with SSI had significantly worse functional outcomes at 3, 6, 12, 24, and 36 months than those without. For patients with SSI, the average Merle d'Aubigné and Majeed scores at 3, 6, 12, 24, and 36 months after injury were 2.4, 4.1, 8.0, 11.0, and 11.3, and 25.5, 32.1, 47.9, 61.9, and 63.3, respectively. Patients with SSI had a higher likelihood of undergoing staged operations (50.0 vs. 13.5%, p = 0.02), more surgeries for associated injuries (6.3% vs. 2.5%, p = 0.04), higher likelihood of Morel-Lavallee lesions (50.0% vs. 5.6%, p = 0.002), higher incidence of diversional colostomy (37.5% vs. 9.0%, p = 0.05), and longer intensive care unit stay (11.1 vs. 3.9 days, p = 0.001) than those without. The contributing factors for SSI were Morel-Lavallee lesions (odds ratio [OR] 4.55, 95% confidence interval [95% CI] 3.34-50.0) and other surgeries for associated injuries (OR 2.37, 95% CI 1.07-5.28). Patients with SSI after osteosynthesis for pelvic ring injuries may have worse short-term functional outcomes.
Collapse
Affiliation(s)
- Chih-Yang Lai
- Department of Orthopedic Surgery, Linkou Branch, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Po-Ju Lai
- Department of Orthopedic Surgery, Linkou Branch, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - I-Chuan Tseng
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan Branch, Taoyuan City, Taiwan
| | - Chun-Yi Su
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung City, Taiwan
| | - Yung-Heng Hsu
- Department of Orthopedic Surgery, Linkou Branch, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Ying-Chao Chou
- Department of Orthopedic Surgery, Linkou Branch, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Yi-Hsun Yu
- Department of Orthopedic Surgery, Linkou Branch, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan.
| |
Collapse
|
7
|
Kellermann F, Hackl S, Leister I, Hungerer S, Militz M, Stuby F, Holzmann B, Friederichs J. Advances in the Treatment of Implant-Associated Infections of the Pelvis: Eradication Rates, Recurrence of Infection, and Outcome. J Clin Med 2023; 12:jcm12082854. [PMID: 37109190 PMCID: PMC10145122 DOI: 10.3390/jcm12082854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION Surgical site infections after operative stabilization of pelvic and acetabular fractures are rare but serious complications. The treatment of these infections involves additional surgical procedures, high health care costs, a prolonged stay, and often a worse outcome. In this study, we focused on the impact of the different causing bacteria, negative microbiological results with wound closure, and recurrence rates of patients with implant-associated infections after pelvic surgery. MATERIAL AND METHODS We retrospectively analyzed a study group of 43 patients with microbiologically proven surgical site infections (SSI) after surgery of the pelvic ring or the acetabulum treated in our clinic between 2009 and 2019. Epidemiological data, injury pattern, surgical approach, and microbiological data were analyzed and correlated with long-term follow-up and recurrence of infection. RESULTS Almost two thirds of the patients presented with polymicrobial infections, with staphylococci being the most common causing agents. An average of 5.7 (±5.4) surgical procedures were performed until definitive wound closure. Negative microbiological swabs at time of wound closure were only achieved in 9 patients (21%). Long-term follow-up revealed a recurrence of infection in only seven patients (16%) with an average interval between revision surgery and recurrence of 4.7 months. There was no significant difference of recurrence rate for the groups of patients with positive/negative microbiology in the last operative revision (71% vs. 78%). A positive trend for a correlation with recurrent infection was only found for patients with a Morel-Lavallée lesion due to run-over injuries (30% vs. 5%). Identified causing bacteria did not influence the outcome and rate of recurrence. CONCLUSION Recurrence rates after surgical revision of implant-associated infections of the pelvis and the acetabulum are low and neither the type of causing agent nor the microbiological status at the timepoint of wound closure has a significant impact on the recurrence rate.
Collapse
Affiliation(s)
- Florian Kellermann
- Trauma Center Murnau, Prof.-Küntscher-Str. 8, 82418 Murnau, Germany
- Department of Surgery, Klinikum Rechts der Isar München, 81675 Munich, Germany
| | - Simon Hackl
- Trauma Center Murnau, Prof.-Küntscher-Str. 8, 82418 Murnau, Germany
| | - Iris Leister
- Trauma Center Murnau, Prof.-Küntscher-Str. 8, 82418 Murnau, Germany
| | - Sven Hungerer
- Trauma Center Murnau, Prof.-Küntscher-Str. 8, 82418 Murnau, Germany
| | - Matthias Militz
- Trauma Center Murnau, Prof.-Küntscher-Str. 8, 82418 Murnau, Germany
| | - Fabian Stuby
- Trauma Center Murnau, Prof.-Küntscher-Str. 8, 82418 Murnau, Germany
| | - Bernhard Holzmann
- Department of Surgery, Klinikum Rechts der Isar München, 81675 Munich, Germany
| | - Jan Friederichs
- Trauma Center Murnau, Prof.-Küntscher-Str. 8, 82418 Murnau, Germany
| |
Collapse
|
8
|
Salášek M, Český R, Whitley A, Šídlo K, Klézl P, Džupa V. Surgical site infections after stabilization of pelvic ring injuries: a retrospective analysis of risk factors and a meta-analysis of similar studies. INTERNATIONAL ORTHOPAEDICS 2023; 47:1331-1344. [PMID: 36867255 PMCID: PMC10079748 DOI: 10.1007/s00264-023-05719-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 02/02/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE Pelvic ring fractures requiring surgical stabilization are severe injuries. Surgical site infections occurring after stabilization of the pelvis are serious complications, requiring complex and multidisciplinary treatment. METHODS This is a retrospective observational study from a level I trauma centre. One hundred and ninety-two patients who underwent stabilization of closed pelvic ring injuries without signs of pathological fracture were selected for inclusion into the study. After excluding seven patients for having incomplete data, the final study group consisted of 185 patients (117 men and 68 women). Basic epidemiologic data and potential risk factors were recorded and analyzed by Cox regression, Kaplan-Meier curves, and risk ratios in 2 × 2 tables. Categorical variables were compared by Fisher exact tests and chi squared tests. Parametric variables were analyzed with Kruskal-Wallis tests with post hoc Wilcoxon tests. RESULTS Surgical site infections occurred in 13% of the study group (24 from 185). Eighteen infections occurred in men (15.4%) and six in women (8.8%). There were two significant risk factors in women: age over 50 years (p = 0.0232) and concomitant urogenital trauma (p = 0.0104). The common risk ratio for both these factors was 212.59 (8.78-5148.68), p = 0.0010. No significant risk factors were identified in men despite younger men having a higher incidence of infection (p = 0.1428). CONCLUSION Overall rate of infectious complications was higher than in the literature, but this might be caused by inclusion of all patients regardless of surgical strategy. Higher age in women and lower age in men were associated with higher infection rates. Concomitant urogenital trauma was a significant risk factor in women.
Collapse
Affiliation(s)
- Martin Salášek
- Department of Orthopaedics and Traumatology, Faculty of Medicine of Charles University, and University Hospital, Pilsen, Czech Republic. .,New Technologies for the Information Society, Faculty of Applied Sciences of University of West Bohemia, Alej Svobody 80, 304 60, Plzeň, Czech Republic.
| | - Richard Český
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Adam Whitley
- Department of Surgery, Third Faculty of Medicine of Charles University, and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Kryštof Šídlo
- Department of Orthopaedics and Traumatology, Third Faculty of Medicine of Charles University, and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Klézl
- Department of Urology, Third Faculty of Medicine of Charles University, and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Valér Džupa
- Department of Orthopaedics and Traumatology, Third Faculty of Medicine of Charles University, and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| |
Collapse
|
9
|
Brahme IS, Hu CH, Cole PA. Infection from an Iliosacral Screw 16 Years Postoperatively in Demolition Derby Umpire Crushed Between 2 Cars: A Case Report. JBJS Case Connect 2023; 13:01709767-202303000-00021. [PMID: 36719947 DOI: 10.2106/jbjs.cc.22.00606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/20/2022] [Indexed: 02/01/2023]
Abstract
CASE A 47-year-old man crushed between 2 cars during a demolition derby, a nonracing North American motorsport, underwent open reduction and internal fixation, iliosacral screw fixation, arterial embolization, and multiple urologic procedures after massive pelvic ring injury, remarkably recovering nearly full function. Sixteen years after injury, he developed an abscess emanating from an iliosacral screw requiring irrigation, debridement, and hardware removal. CONCLUSION Deep surgical infections from iliosacral screws may present late, even more than 15 years after the original surgery. Obesity, preoperative embolization, diabetes, and urethral injuries are relevant risk factors. Similar patients should have a low threshold for infection workup when presenting with symptoms, even years after surgery.
Collapse
Affiliation(s)
- Indraneel S Brahme
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota.,Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota
| | - Caroline H Hu
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota.,Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota
| | - Peter A Cole
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota.,Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota.,HealthPartners Orthopaedics & Sports Medicine, Bloomington, Minnesota
| |
Collapse
|
10
|
Alt V, Giannoudis PV. Musculoskeletal infections: A call for papers to continue the battle against this devastating global challenge. Injury 2021; 52:3187-3188. [PMID: 34740386 DOI: 10.1016/j.injury.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Volker Alt
- Director and Chairman, Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany.
| | - Peter V Giannoudis
- Professor-Section Head, Trauma & Orthopaedic Surgery, School of Medicine, University of Leeds, UK
| |
Collapse
|