Impact of closed suction drainage after surgical fixation of acetabular fractures

Boissonneault, Adam; Schenker, Mara L.; Staley, Christopher; Roorbach, Madeline; Erwood, Amalie A.; Grabel, Zachary J.; Moore, Thomas J.; Reisman, W. Michael; Maceroli, Michael

doi:10.1007/s00402-019-03110-0

Cited by 7 publications

(6 citation statements)

References 30 publications

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“…A retrospective study by Reddix et al (23) showed that the use of CSD in patients with acetabular fracture may significantly reduce the incidence of deep infections. Although certain high-risk patients with acetabular fractures, such as obese patients, may benefit from treatment with CSD, the use of CSD remains (24) show that, in their study, the use of CSD after the surgical fixation of acetabular fractures via the Kocher-Langenbeck approach significantly increased postoperative blood transfusion rates and days in hospital, but wound complications and incision infection rates did not differ.…”

Section: Discussionmentioning

confidence: 97%

Drain vs. no-drain for acetabular fractures after treatment via a modified stoppa approach: A retrospective study

Jin

Wang²,

Zhao³

et al. 2023

Front. Surg.

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ObjectiveThe aim of this study was to compare the clinical efficacy of close suction drainage (CSD) and no-CSD after a modified Stoppa approach for the surgical fixation of acetabular fractures.MethodsThis retrospective study included 49 consecutive acetabular fracture patients, who presented to a single level I trauma center for surgical fixation, using a modified Stoppa approach from January 2018 to January 2021. All surgeries were performed by a senior surgeon using the same approach, and the patients were divided into two groups based on whether CSD was used after the operation. Details of the patient demographics, fracture characteristics, intraoperative indicators, reduction quality, intra and postoperative blood transfusion, clinical outcomes, and incision-related complications were collected.ResultsNo significant differences were found in the demographics, fracture characteristics, intraoperative indicators, reduction quality, clinical outcomes, and incision-related complications between the two groups (P > 0.05). The use of CSD was associated with a significantly higher postoperative blood transfusion volume (P = 0.034) and postoperative blood transfusion rate (P = 0.027). In addition, there was a significant difference in postoperative temperatures, especially on postoperative Day 2 (no-CSD 36.97 ± 0.51°C vs. CSD 37.34 ± 0.69°C, P = 0.035), and higher visual analogue scale (VAS) scores, especially on postoperative Day 1 (no-CSD 3.00 ± 0.93 vs. CSD 4.14 ± 1.43, P = 0.002) and 3 (no-CSD 1.73 ± 0.94 vs. CSD 2.48 ± 1.08, P = 0.013).ConclusionThe results of this study suggest that routine use of CSD should not be recommended for patients with acetabular fractures after surgical fixation using a modified Stoppa approach.

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Section: Discussionmentioning

confidence: 97%

Drain vs. no-drain for acetabular fractures after treatment via a modified stoppa approach: A retrospective study

Jin

Wang²,

Zhao³

et al. 2023

Front. Surg.

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“…The use of closed suction drains is surgeon-dependent but has been associated with increased transfusions and length of stay with no difference in the infection rate. 43 Standard postoperative pain control and thromboprophylaxis protocols are followed. Weight-bearing restrictions are typically touch down for 6 to 8 weeks but may be modified for cases with marginal impaction or cranial joint involvement.…”

Section: Surgical Managementmentioning

confidence: 99%

“…The use of closed suction drains is surgeon-dependent but has been associated with increased transfusions and length of stay with no difference in the infection rate. 43…”

Section: Treatmentmentioning

confidence: 99%

“…Utilization of prophylactic antibiotics helps to mitigate infection while placement of suction drains to prevent hematoma formation and close dead space does not necessarily decrease infection nor wound healing complications. 43 Acute sciatic nerve palsy secondary to hematoma formation has been described and requires prompt recognition and surgical evacuation. 44 Risk of DVT is also decreased by utilization of intermittent compressive devices and chemical anticoagulation.…”

Section: Complicationsmentioning

confidence: 99%

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Evaluation and Management of Posterior Wall Acetabulum Fractures

Perdue

Tainter

Toney

et al. 2021

J Am Acad Orthop Surg

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Posterior wall acetabulum fractures typically result from high-energy mechanisms and can be associated with various orthopaedic and nonorthopaedic injuries. They range from isolated simple patterns to multifragmentary with or without marginal impaction. Determination of hip stability, which can depend on fragment location, size, and displacement, directs management. Although important in the assessment of posterior wall fractures, CT is unreliable when used to determine stability. The dynamic fluoroscopic examination under anesthesia (EUA) is the benchmark in assessment of hip stability, and fractures deemed stable by EUA have good radiographic and functional outcomes. In fractures that meet surgical criteria, accurate joint reduction guides outcomes. Joint débridement, identification and elevation of impaction, and adjunctive fixation of posterosuperior and peripheral rim fragments along with standard buttress plate fixation are critical. Complications of the fracture and surgical fixation include sciatic nerve injury, posttraumatic osteoarthritis, osteonecrosis of the femoral head, and heterotopic ossification. Although accuracy of joint reduction is paramount for successful results, other factors out of the surgeon's control such as comminution, femoral head lesions, and dislocation contribute to poor outcomes. Even with anatomic restoration of the joint surface, good clinical outcomes are not guaranteed and residual functional deficits can be expected.

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“…[9][10][11][12][13][14][15][16] The outcomes and complications of operative management in pelvic and acetabulum fractures have been shown to be influenced by multiple factors, including: female sex, chest injury, severe traumatic brain injury, increased body mass index (BMI), open fractures, use of surgical low pressure vacuum drains and surgical approach. 4,6,10,11,17,18 Another factor that has previously been associated with complications in patients with pelvic and acetabular fractures is an increased Injury Severity Score (ISS). 10,18,19 Complications within three years include wound infection 2-13%, deep venous thrombosis (DVT) 27%, metalware failure 1.5%, unplanned reoperation, iatrogenic neurological injuries 5.3%, heterotopic ossification and mortality of 5-15% but can be as high as 50% with open fractures.…”

Section: Introductionmentioning

confidence: 99%

Complications of surgically managed pelvic and acetabular fractures

et al. 2023

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BACKGROUND: High energy pelvic and acetabular fractures frequently occur in conjunction with multiple system injuries and have been associated with morbidity and mortality. We aimed to identify the risk factors associated with complications in patients with pelvic and/or acetabular fractures treated surgically in a resource-constrained clinical setting. METHODS: We performed a retrospective review of adult patients younger than 65 years treated surgically over a three-year period at a tertiary and regional hospitals in South Africa. Epidemiological data as well as trauma-, fracture- and treatment-related factors were compared in patients who developed complications and those who did not, at a mean follow-up of ten months (interquartile range 4-14 months; range 0-31. RESULTS: Eighty-eight patients were included. Complications were encountered in 41% of the cohort. Factors associated with adverse events were age above 35 years (p = 0.008); transverse sacral fractures (p = 0.008); partial articular acetabular fractures with isolated column and/or wall involvement (p = 0.014); Kocher-Langenbeck approach (p = 0.001); posterior acetabular wall fixation (p = 0.002); fixation with plate and screws (p = 0.012); and follow-up period more than 6 months (p = 0.025). Complications encountered were heterotopic ossification, postoperative sepsis, unplanned reoperation, implant failure, postoperative neurological deficit, venous thromboembolism, femoral head osteonecrosis, osteoarthritis and limb length discrepancy. No association was found between adverse events and injury severity score, comorbidities or other associated injuries. CONCLUSION: Complications were common within three years in patients with pelvic and acetabular fractures treated surgically in a developing setting. While an increased Injury Severity Score was not associated with complications, certain fracture- and surgery-related factors may be associated with an increased risk. Heterotopic ossification was the most common adverse event despite formal gluteus minimus debridement and the use of NSAIDs. Further studies are needed to determine the medium- to long-term complications as well as the functional outcome of surgery and the complications of surgery. Level of evidence: Level 4.

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Impact of closed suction drainage after surgical fixation of acetabular fractures

Cited by 7 publications

References 30 publications

Drain vs. no-drain for acetabular fractures after treatment via a modified stoppa approach: A retrospective study

Drain vs. no-drain for acetabular fractures after treatment via a modified stoppa approach: A retrospective study

Evaluation and Management of Posterior Wall Acetabulum Fractures

Complications of surgically managed pelvic and acetabular fractures

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