Complications of pelvic ring fixation in patients requiring laparotomy

Miskimins, Richard; Decker, Michael; Hobby, Bryon D.; Howdieshell, Thomas R.; Lu, Stephen W.; West, Sonlee D.

doi:10.1016/j.jss.2015.05.051

Cited by 7 publications

(7 citation statements)

References 13 publications

(14 reference statements)

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“…These measures are thought to be effective in stopping haemorrhage, however, they also have potential side effects. While some studies identified independent risk factors for infections in pelvic fractures such as degree of instability [2], embolization [3] or laparotomy [4]; other trials found no association between re-operations and patient's treatment or other injury-associated factors [5]. It is still a matter of debate whether a primary stabilization with C-clamp or external fixation changes the complication pattern or increases the risk of local infections.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and complications of primary C-clamp stabilization or external fixation for unstable pelvic fractures

Schmal

Larsen

Stuby

et al. 2019

Injury

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Background and purpose Unstable pelvic fractures frequently require emergency stabilization using a C-clamp or external (CC/EF) fixation. However, the effectiveness of this intervention and associated complications are still a matter of debate. Patients and methods The analysis used data available from the German Pelvic Trauma Registry to study general complications, infections and mortality after primary stabilization using CC/EF in 5,499 patients (n=957 with vs n=4,542 without). Furthermore, the subgroups with secondary surgery (n=713 vs n=1,695), and ilio-sacral screw implantation following C-clamp stabilization were evaluated (n=24 vs n=219). Calculated odds ratios were adjusted for potential confounders. Results Patients treated by CC/EF were younger (45±20 vs 62±24 years), had more C-type fractures (65% vs 28%), higher ISS (≥25 63% vs 20%) and displacement (≥3mm 81% vs 41%), and more complex fractures (32% vs 5%). These features were independent risk factors for complications (p<0.001). While mortality was reduced after CC/EF stabilization by 32% (OR 0.68 95%CI 0.49-0.95), the risk for general complications was slightly increased (OR 1.25 95% CI 1.02-1.53). In patients undergoing secondary surgery, CC/EF fixation had no influence on mortality, general complications or infections. Related to preceding C-clamp stabilization (OR 4.67 95% CI 1.06-20.64), the risk for infection increased from 3.2% to 20.8% in ilio-sacral screw fixation. Interpretation Primary stabilization of unstable pelvic fractures with C-clamp or external fixation is associated with a decreased mortality and was not an independent risk factor for complications after secondary surgery. However, the risk for infection after ilio-sacral screw fixation increased almost 5-fold after C-clamp use.

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Section: Introductionmentioning

confidence: 99%

Effectiveness and complications of primary C-clamp stabilization or external fixation for unstable pelvic fractures

Schmal

Larsen

Stuby

et al. 2019

Injury

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“…Surgical treatment depends on instability of the pelvic ring, the length of time from the injury and the extent of the infection. Soft tissue infections without concomitant pelvic instability can be treated by surgical revision with excision of the inflamed and devitalized tissue and lavage and drainage [13]. When a skin defect results after such treatment, it can be treated by using vacuum assisted closure or closed with a skin graft with the aid of a plastic surgeon [13,14,16].…”

Section: Discussionmentioning

confidence: 99%

“…Soft tissue infections without concomitant pelvic instability can be treated by surgical revision with excision of the inflamed and devitalized tissue and lavage and drainage [13]. When a skin defect results after such treatment, it can be treated by using vacuum assisted closure or closed with a skin graft with the aid of a plastic surgeon [13,14,16]. Cases of osteomyelitis and failure of osteosynthesis should be treated by removing osteosynthetic material, stabilization of the pelvic ring by external fixation, and in cases of instability of the posterior segment by mini-invasive fixation (for example, iliosacral screws) [4].…”

Section: Discussionmentioning

confidence: 99%

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Surgical site infections after stabilization of pelvic ring injuries: a retrospective analysis of risk factors and a meta-analysis of similar studies

Salášek

Český

Whitley

et al. 2023

International Orthopaedics (SICOT)

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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.

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“…Unstable complex pelvic fractures are challenging for orthopedic trauma surgeons, having high morbidity, mortality, and healthcare costs, and they are increasing in incidence [1][2][3]. Postoperative complications of pelvic fracture, which are related to suboptimal bone healing and various degrees of inability to transfer load from the trunk to the lower limbs, render the restoration and operative stabilization of the pelvic ring an imperative goal [4].…”

Section: Introductionmentioning

confidence: 99%

Radiological measurement of pelvic fractures using a pelvic deformity measurement software program

Zhang

et al. 2020

J Orthop Surg Res

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Background: It is difficult for the surgeon to measure pelvic displacement in the closed reduction operation for unstable pelvic fracture. We therefore developed a pelvic deformity measurement software program based on standardized radiographs. The objectives of the present study were to evaluate the inter-observer reliability of the program for measuring specific fracture types on preoperative pelvic films and to assess the validity of the measurement software program by comparing it with a gold standard. Methods: Twenty-five patients diagnosed with AO/OTA type B or C pelvic fractures with the unilateral pelvis fractured and dislocated were included in this study. Four separate observers repeatedly determined the translational and rotational patterns and outcomes using the software program and hand measurement, and calculated the displacement using computed tomography (CT) coupled with a three-dimensional (3D) CT model. The validity of the measurement software was calculated by assessing the consistency between the software measurements and the gold standard. Additionally, inter-observer reliability was assessed for the software. The software was also applied in preliminary clinical practice for closed reduction procedures. Results: The overall inter-observer reliabilities of the software program, CT coupled with 3D reconstruction, and hand measurements were high, with kappa values of 0.956, 0.958, and 0.853, respectively. The software showed validity similar to that of CT coupled with 3D reconstruction (0.939 vs. 0.969), and better than that of hand measurement (0.939 vs. 0.858). A preliminary clinical application demonstrated that the software is effective for guiding closed reduction of pelvic fractures. Conclusions: Our newly established pelvic deformity measurement program is a reliable and accurate tool for analyzing pelvic displacement patterns and can be used for guidance of closed reduction and planning of the reduction pathway.

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Complications of pelvic ring fixation in patients requiring laparotomy

Cited by 7 publications

References 13 publications

Effectiveness and complications of primary C-clamp stabilization or external fixation for unstable pelvic fractures

Effectiveness and complications of primary C-clamp stabilization or external fixation for unstable pelvic fractures

Surgical site infections after stabilization of pelvic ring injuries: a retrospective analysis of risk factors and a meta-analysis of similar studies

Radiological measurement of pelvic fractures using a pelvic deformity measurement software program

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