Infection of non-operatively managed acetabular fracture via a suprapubic catheter

Updated Outcomes of Early Endoscopic Realignment for Pelvic Fracture Urethral Injuries at a Level 1 Trauma Center

OBJECTIVE

To present our updated experience and discuss potential benefits of early endoscopic realignment (EER) for patients with pelvic fracture urethral injuries (PFUIs).

METHODS

A retrospective review of patients treated with EER after blunt PFUIs was performed. EER was performed with a retrograde or a combined antegrade or retrograde approach with a cystoscope. Treatment success was defined as no secondary procedure or the ability to pass a cystoscope across the area of injury or surgical anastomosis.

RESULTS

Thirty-two patients (mean age 38 years, range 17-73) underwent EER between 2004 and 2016 with a mean follow-up of 26 months (range 1-102). Median time to realignment was 2 days (range 0-6) and was performed concomitantly with another surgical service in 72% of cases. Median operative time for EER was 38 minutes (range 8-100). Using an intent-to-treat analysis, 29 patients (91%) failed EER. Nine patients underwent a subsequent endoscopic procedure with 22% success rate. Excision and primary anastomotic urethroplasty was performed in 24 patients as a primary or secondary treatment with 96% success rate.

CONCLUSION

Our overall success rate for EER was 9%, but did not hinder subsequent urethroplasty success. The decision for performing EER should not be based on success alone. Secondary benefits of EER exist and may assist with the multidisciplinary care of a patient with complex trauma. The management of PFUI is challenging and these patients should be referred to tertiary centers.

Infection after fracture osteosynthesis - Part I

Bone and surgical site infections after osteosynthesis are notoriously difficult to manage and pose a tremendous burden in fracture management. In this article, we use the term osteosynthesis-associated infection (OAI) to refer to this clinical entity. While relatively few surgically treated fractures become infected, it is challenging to perform a rapid diagnosis. Optimal management strategies are complex and highly customized to each scenario and take into consideration the status of fracture union, the presence of hardware and the degree of mechanical stability. At present, a high level of relevant evidence is unavailable; most findings presented in the literature are based on laboratory work and non-randomized clinical studies. We present this overview of OAI in two parts: an examination of recent literature concerning OAI pathogenesis, diagnosis and classification and a review of treatment options.