Fri., 10/17/08 Pelvis/Injury Prevention, Paper #26, 11:20 am OTA-2008
Embolization of Pelvic Arterial Injury Is a Risk Factor for Deep Infection after Acetabular Fracture Surgery
Ted T. Manson, MD (n); Paul W. Perdue, BS (n); Andrew N. Pollak, MD (n);
Robert V. O’Toole, MD (a-AO, DePuy, FOT, Smith + Nephew, Stryker, Synthes, Wyeth; e-Synthes);
R. Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland
School of Medicine, Baltimore, Maryland, USA
Purpose: Multiply injured patients with acetabular fractures are occasionally treated with embolization of pelvic vessels to control hemorrhage during initial trauma resuscitation. Such embolization may compromise local pelvic blood supply and thus increase the risk of infection after open reduction and internal fixation (ORIF) of their acetabular fractures. Our hypothesis was that embolization of pelvic arterial injuries is associated with an unacceptably high rate of deep infection after ORIF of acetabular fractures.
Methods: We retrospectively reviewed all patients who underwent ORIF for an acetabular fracture from July 1995 to October 2007 (N = 1440). We matched this with a list of all patients who underwent angiography of a pelvic arterial injury during the same time period to form our study group (n = 32). All patients underwent angiography for hemodynamic instability or ongoing blood loss. Our primary outcome was presence of any infection that required return to the operating room within 1 year of the initial procedure. We compared patients with acetabular fractures who were treated with angiography but did (n = 14) and did not (n = 18) have embolization of a pelvic artery.
Results: 7 of the 14 (50%) embolized patients developed infection that required surgical débridement. These 14 patients all had a branch of their internal iliac artery embolized. The average Injury Severity Score (ISS) of these patients was 33.9. Two of the infected patients had ORIF of their acetabular fracture through a Kocher-Langenbeck exposure and five through an ilioinguinal exposure. Two of the infected patients also had a pelvic ring fracture. Of the 18 patients who underwent angiography prior to acetabular ORIF but did not require pelvic embolization, only 2 (11%; P <0.05, Fisher exact) required return to the operating room for débridement of infection. The average ISS of these patients was high (22.0) but significantly lower than that of the embolized patients (P <0.05).
Conclusions: The combination of an acetabular fracture that requires ORIF and a pelvic arterial injury that requires angiographic embolization is rare (only 1% of our acetabular fractures). The infection rate in the patients who received embolization was 50%, which is significantly higher than typical historical controls (2%-5%, P <0.05) and significantly higher than that of a control group of patients who underwent angiography without embolization. These patients’ multisystem injuries may contribute to the increased propensity for infection. Surgeons should be aware, however, that embolization of pelvic arterial injury may increase the risk of infection associated with ORIF of acetabular fractures.
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. Δ OTA Grant.