Fri., 10/19/07 Pelvis, Paper #29, 11:48 am OTA-2007
The Treatment of Pelvis Fractures with Associated Urologic Injury: Does the Type of Fixation Influence the Risk of Complications?
Pierre Guy, MD, MBA, FRCSC (a-Synthes, Stryker); Fayez al-Sayegh, MD, FRCSC (n);
Division of Orthopedic Trauma, Department of Orthopedics,
University of British Columbia, Vancouver, British Columbia, Canada
Introduction and Objective: The management of pelvic fractures with urinary disruption is controversial, with potential contamination of anterior open reduction and internal fixation (ORIF) by bladder or urethral injuries and possible deep infection and nonunion. External fixation (EF) is advocated by some to avoid such problems, on theoretical grounds of limited soft-tissue disruption. This advantage, however, has not been clearly substantiated. The purpose of this study is to describe the epidemiology of these injuries and to compare the risk of deep-wound infection in patients with pelvic fractures and urinary disruption treated with ORIF versus EF.
Methods: We conducted a retrospective review of prospectively collected data on patients treated at a tertiary trauma center between 1999 and 2006. Demographics, injury characteristics, treatment, and outcomes (infection, nonunion) of adults sustaining pelvic fractures with associated urinary disruption and treated by ORIF or EF were analyzed. Of the 444 pelvis fractures operated on over that period, 78 cases had an associated urologic injury. Mean age was 35 years (standard deviation [SD] 13); mean ISS, 28 (SD 10); sex, 65% male, 35% female; and AO/OTA types were A 3.8%, B 48.7%, C 47.4%. There were 13 open fractures (17%). Urologic injuries were 64% bladder, 22% urethra, 6% combined bladder-urethra, and 8% associated pelvic organ injury. Treatment was ORIF in 49 (63%) and EF in 29 (37%).
Results: ORIF and EF groups showed no statistically significant difference (P values indicated) in age (.07) and ISS (.22) by t test, or fracture type (.92), Gustilo classification (.08), or urologic injury (.11) by chi-square. Early deep-wound infection occurred in 2 of 48 (4.1%) ORIF cases, and in 1 of 29 (3.4%) EF cases. The differences were not statistically significant (chi-square test). There were no nonunion cases and no late deep-wound infection in either group. The infection rate was, however, significantly different than in the entire pelvis fracture cohort of 433 cases, which is 0.9%.
Conclusion and Significance: EF showed no advantage with respect to infection rate, with the rate of deep infection in both ORIF and EF showing no statistically significant difference. Despite its statistical power limitations, this study assembles the largest cohort with this combination of injuries and guides the orthopaedic surgeon in his or her treatment decisions.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing.