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

Abstract

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.

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

“…The treatment strategy for infectious complications after pelvic ring stabilization requires an individual approach and good interdisciplinary cooperation as guidelines based on prospective clinical trials are still lacking. In terms of cohort sizes, our study is comparable with two recent studies also devoted to pelvic infections: Bakhshayesh et al 2018 [2] and Kanakaris et al 2021 [10]. Bakhshayesh et al reported a similar proportion of reoperations for surgical site infections as in our study.…”

“…However, in contrast with our study, a post hoc analysis on sex-based subgroups was not performed [2]. In Kanakaris et al's study, a larger number of risk factors were investigated, logistic regression was used for the analysis rather than Cox regression, and in their multivariate analysis ISS score, diabetes, a posterior approach, and alcohol abuse were all identified as independent risk factors [10]. Other studies focused on fewer risk factors than our study.…”

“…For diagnosing surgical site infection after the operative treatment of pelvic fractures, we rely on local signs of infections, the qSOFA score, laboratory signs (leukocytosis with left shift and elevation of CRP and procalcitonin), and imaging method findings (sonography of the soft tissues in the region of the surgical wound and computed tomography of the pelvis). Similar diagnostic methods have been recommended by many other authors [3,7,10,11,16,28]. Additionally, other authors recommend using a combination of SPECT and CT or SPECT and MRI, as this has a higher sensitivity for diagnosing infections.…”

Implant retention with serial debridement and use of antibiotic-loaded calcium sulfate beads in acute fracture-related infection (FRI) after pelvic ring or acetabular fractures: A retrospective case series of 7 cases

“…The small sample size, the retrospective nature of the study, the relative short-term follow-up and combination of acute fractures with malunited cases are the main ones. On considering that pelvic fractures make up approximately 3% of all fractures, and that prevalence of surgical site infection following fixation of pelvic ring injury is 2.1% [3] , this disastrous complication fortunately represents a rare occurrence. This limits collection of an adequate sample in a single center.…”

“…Definitive operative intervention usually requires extensive surgical approaches, massive soft tissue dissection and lengthy procedures [2] . The prevalence of surgical site infection following fixation of pelvic ring injury is 2.1% [3] . The immunosuppressive state induced by trauma, open extremity associated injuries, massive blood loss, intensive care admission predispose to both local and systemic infections.…”