Lower risk of pelvic metalware infection with operative repair of concurrent bladder rupture

Yao, Henry Han‐I; Esser, Max; Grummet, Jeremy; Atkins, Chris; Royce, Peter; Hanegbi, Uri

doi:10.1111/ans.14233

Cited by 12 publications

(15 citation statements)

References 9 publications

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“…Other factors as the history of pelvic embolisation, pelvic packing, use of external fixators/C-Clamps, the presence of a suprapubic catheter, or of Morel-Lavallee lesions or the large number of transfusions and evidence of post-traumatic immunoparesis were not confirmed in this study in contrast to the previous reports. [ 44 – 49 ]. These differences could be attributed to the small incidence of SSI in our cohort, leaving only 18 cases of recorded deep infection to analyse.…”

Section: Discussionmentioning

confidence: 99%

Deep infection following reconstruction of pelvic fractures: prevalence, characteristics, and predisposing risk factors

Kanakaris

Ciriello

Stavrou

et al. 2021

Eur J Trauma Emerg Surg

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Purpose To identify the incidence, risk factors, and treatment course of patients who developed deep infection following fixation of pelvic fractures. Methods Over a period of 8 years patients who underwent pelvic reconstruction in our institution and developed postoperative infection were included. Exclusion criteria were pathological fractures and infections that were not secondary to post-traumatic reconstruction. The mean time of follow-up was 43.6 months (33–144). For comparison purposes, we randomly selected patients that underwent pelvic fracture fixation from our database (control group). A logistic regression was fitted to patient characteristics including age, sex, ISS, and diabetic status. Results Out of 858 patients, 18 (2.1%) (12 males), with a mean age of 41 (18–73) met the inclusion criteria. The control group consisted of 82 patients with a mean age of 41 years (18–72). The mean ISS was 27.7 and 17.6 in the infection and control group, respectively. The mean time from pelvic reconstruction to the diagnosis of infection was 20 days (7–80). The median number of trips to theatre was 3 (1–16). Methicillin-resistant Staphylococcus aureus (MRSA) was the most frequently isolated organism in the years prior to 2012. Eradication was achieved in 93% of the patients. The most important risk factors for deep infection were ISS (OR 1.08, 1.03–1.13), posterior sacral approach (OR 17.03, 1.49–194.40), and diabetes (OR 36.85, 3.54–383.70). Conclusion In this retrospective case–control study, deep infection following pelvic trauma was rare. A number of patient-, injury- and surgery-related factors have shown strong correlation with this serious complication.

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Section: Discussionmentioning

confidence: 99%

Deep infection following reconstruction of pelvic fractures: prevalence, characteristics, and predisposing risk factors

Kanakaris

Ciriello

Stavrou

et al. 2021

Eur J Trauma Emerg Surg

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“…In a recent retrospective cohort of 45 bladder trauma patients, the authors reported lower rate of pelvic hardware infection in patients managed with surgical repair than those managed nonoperatively (33% vs. 5.6%, P = .047). 25 However, when only comparing the patients with EBIs (n = 28), this difference did not reach statistical significance ( P = .08). Of note, only 5 patients in this series had pelvic hardware infection with 2 of them being in the surgical repair cohort, emphasizing the lack of statistical power and the narrow margin for the results to be changed in either direction with 1 or 2 cases.…”

Section: Reviewmentioning

confidence: 89%

“…Of note, only 5 patients in this series had pelvic hardware infection with 2 of them being in the surgical repair cohort, emphasizing the lack of statistical power and the narrow margin for the results to be changed in either direction with 1 or 2 cases. 25 In another retrospective review of 80 EBI patients, Johsnsen et al suggested that overall complication rates and hospital stay were lower in EBIs that were surgically repaired at the time of other nonurologic interventions than those who underwent interventions without fixing the bladder. 13 However, only 1 of the 28 patients who underwent ORIF had a pelvic hardware infection, so no conclusion can be reached on the rate of orthopedic complications and the role of concomitant bladder surgery at the time of ORIF based on these data.…”

Section: Reviewmentioning

confidence: 99%

Extraperitoneal Bladder Injuries Associated With Pelvic Fracture Requiring Internal Fixation: What Is the Evidence?

Khabiri

Keihani

Myers

2020

The American Surgeon

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Traumatic bladder injuries are commonly associated with pelvic fractures. While the majority of intraperitoneal bladder injuries are surgically repaired, extraperitoneal bladder injuries (EBIs) can be managed nonoperatively in the absence of complex injury patterns such as bladder neck injury or presence of bone spicules in the bladder. Concern for pelvic hardware contamination is one of the most common reasons for repairing EBIs at the time of orthopedic interventions for pelvic fracture (usually open reduction and internal fixation). However, given the inconsistent and limited evidence, practice patterns are different and largely depend on surgeon preferences and institutional management. In this review, we explore the roots for this concern and summarize the current evidence on risk of pelvic hardware infection with nonoperative management of EBIs.

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“…Extra-peritoneal bladder ruptures can be managed non-operatively with catheter drainage alone. 3,4,10,[21][22][23][24] Indications for operative repair of EBR include: failure of conservative management 1,21 ; the presence of associated vaginal, 1,21 prostate 21 or rectal injury 1,22,24 ; involvement of the bladder neck 1,21,22,24 ; bony fragments present within the bladder wall 22,24 ; laparotomy for an additional indication 1,21,22 ; fracture pelvis requiring internal fixation 1,22,24,27,28 ; or a penetrating injuries. 1,21,22 In our cohort, the high incidence of concurrent injuries requiring operative intervention accounted for the high rates of intraoperative repair (56.2%) for our patients with EBR.…”

Section: Discussionmentioning

confidence: 99%

A 12-year experience in the management of traumatic bladder rupture at an Australian level 1 trauma centre

Yao

Fletcher

Grummet

et al. 2022

Journal of Clinical Urology

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Objective: To review the contemporary bladder trauma epidemiology, diagnosis and management over a 12-year period at a level 1 trauma centre in Australia. Patients and Methods: From July 2001 through June 2013, 97 multi-trauma patients at a level 1 trauma centre in Australia were identified to have sustained bladder rupture. Data on demographics, clinical presentation, diagnosis, management and complications were extracted from the TraumaNET database, medical records and health-coding database. Results: Of the 97 patients, 98% of bladder ruptures resulted from blunt trauma mostly from road accidents. There was a male preponderance of 64%. Intra-peritoneal bladder rupture (51%) was the most common type of injury followed by extra-peritoneal bladder ruptures (42%) and combined intra- and extra-peritoneal bladder ruptures (7%). Concomitant pelvic fractures occurred in 78% of patients and concurrent intra-abdominal injuries in 68%. Initial imaging missed 28% of bladder ruptures, with computed tomography with intravenous contrast missing 65% of bladder ruptures. The majority of intra-peritoneal bladder ruptures and 56% of extra-peritoneal bladder ruptures were repaired surgically, with 83% of repairs performed in conjunction with another surgical procedure. The in-hospital mortality rate was 9%, and all deaths were due to concomitant injuries. Conclusion: Traumatic bladder rupture is associated with a 9% mortality rate due to the frequently associated significant concurrent injuries. Computed tomography cystogram or plain cystogram is the imaging modality of choice in diagnosing bladder rupture. Intra-peritoneal bladder ruptures should be repaired surgically, while extra-peritoneal bladder ruptures can be treated conservatively in selected patients. The timing of surgical repair should be coordinated with other specialties. Level of evidence: 4

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Lower risk of pelvic metalware infection with operative repair of concurrent bladder rupture

Abstract: Operative repair of bladder rupture is associated with a lower rate of pelvic orthopaedic hardware infection in the presence of concurrent pelvic fracture requiring internal fixation.

Cited by 12 publications

References 9 publications

Deep infection following reconstruction of pelvic fractures: prevalence, characteristics, and predisposing risk factors

Deep infection following reconstruction of pelvic fractures: prevalence, characteristics, and predisposing risk factors

Extraperitoneal Bladder Injuries Associated With Pelvic Fracture Requiring Internal Fixation: What Is the Evidence?

A 12-year experience in the management of traumatic bladder rupture at an Australian level 1 trauma centre

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