Rates and risk factors of complications associated with operative treatment of pelvic fractures

Abstract

Purpose Post-operative complications following fixation of pelvic fractures can lead to mortality and increased morbidity. Available literature regarding complications is heterogeneous and knowledge on risk factors is limited. This study aims to identify the most common post-operative complications and their possible risk factors following pelvic fracture surgery. Methods A retrospective cohort study was performed in two level-1 trauma centers in the Netherlands between January 2015 and January 2021. Included patients were all adult patients (≥ 18 years) with an operatively treated pelvic fracture (pelvic ring and/or acetabular fractures). Post-operative complications included surgical site infections (SSI), material-related complications, neurological complications, malunion/non-union and performed reoperations. A forward stepwise multivariable logistic regression analysis was used to identify any risk factors associated with these complications. Results Complications occurred in 55 (24%) of the 233 included patients. SSI’s were most common, occurring in 34 (15%) patients. Duration of surgery (odds ratio 1.01 per minute, 95% confidence interval 1.00–1.01) and obesity (odds ratio 1.10 per BMI point, 95% confidence interval 1.29–7.52) were independent risk factors for development of SSI. Less common post-operative complications were material-related complications (8%) and neurological damage (5%). Conclusion Limiting operation time by using less invasive and less time-consuming surgical approaches may reduce the risk of SSI. More awareness and post-operative screening for early signs of SSI is mandatory, especially in obese patients. Future research should include large prospective patient cohorts to determine risk factors for other post-operative complications associated with pelvic fracture surgery.

Late surgical correction after complex unstable pelvic fracture 61 C3 (OTA/AO) of an 18-year-old woman

“…Surgical treatment of pelvic malunion is technically challenging and is associated with increased risk of complications, particularly in under-resourced areas. [8][9][10] Early specialized care to prevent pelvic deformity is preferable. However, if unintended malunion occurs, a systematic approach to correcting the deformity is essential for improving patient outcomes and preventing further complications.…”

“…2,7,11 Currently, there is a paucity of literature describing these treatment algorithms. 7,8,12 This lack of information is primarily due to the efficiency of acute care from highly resourced trauma centers and specialized pelvis surgeons. 10,13 To improve patient outcomes globally, this case report describes the principles and careful planning required to perform reconstructive osteotomies for pelvis malunion, specifically focusing on surgery within a middle-income country health care system that has some access to advanced imaging and surgical expertise.…”

“…The complexity of the surgery can lead to substantial blood loss, neurologic injury, venous thromboembolism, vascular or visceral injury, infection, and implant failure. 8,9 In underserved areas, correcting pelvic malunion is challenging, exacerbating socioeconomic disparities and poor patient outcomes. 10 Depending on the rotational deformity and degree of vertical displacement, one-stage or multistage reconstruction is required.…”