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Infection, fixation failure may lead to unplanned reoperation after surgery for pelvic ring fracture
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Common indications for unplanned reoperation after surgery for treatment of unstable pelvic ring fractures included infection and fixation failure, according to a recently published study.
“Pelvic ring injuries are often devastating injuries,” study author George Ochenjele, MD, told Healio.com/Orthopedics. “Postoperative complications that require unplanned reoperations are unfortunately relatively common, and infection and loss of fixation are the two most common reasons for these reoperations. The severity of pelvic and abdominal injuries are independent risk factors for complications; and modifiable factors, such as fixation or treatment strategies, are not independent predictors of unplanned reoperations.”
He added, “These complications are inherent and unlikely unavoidable; however, this knowledge should still be valuable to the treating surgeon with preoperative patient counseling and setting appropriate expectation.”
At a level 1 trauma center, researchers retrospectively reviewed the medical records of 913 patients with unstable pelvic ring fractures surgically treated between 2003 and 2015. Relative contributions of correlated clinical parameters to unplanned reoperations were determined with multiple logistic regression analysis. The impact of multiple covariates was evaluated with a risk prediction model.
Results showed unplanned reoperations were needed for 137 fractures. Overall, the rate of unplanned reoperations was 15%. Investigators noted within 1 month following the index procedure, most reoperations occurred due to infection and fixation failure. Independent predictors of reoperation included open fractures, combined pelvic ring and acetabular injuries, abdominal visceral injuries and increasing pelvic ring grade. There was no independent correlation between reoperation and patient, treatment or other injury factors. – by Monica Jaramillo
Disclosure s : The authors report no relevant financial disclosures.
Perspective
Back to TopAshoke Sathy, MD
The study, “Predictors of unplanned reoperation after operative treatment of pelvic ring injuries” by Ochenjele and his colleagues out of the R Adams Cowley Shock Trauma Center in Baltimore is a retrospective review of prospectively collected data from their trauma database from 2003 to 2015. The study’s purpose was to identify predictors for unplanned reoperation for operatively treated pelvic ring injuries (with or without an associated acetabular fracture). Unplanned reoperation was found in 137/913 patients for an overall rate of 15% (8% for infection, 6% for fixation failure). Median time to reoperation was approximately 3 weeks. Four independent predictors were found: open fractures, combined pelvic and acetabular injuries, abdominal visceral injuries and increasing pelvic fracture grade using the Young-Burgess system.
The main limitation is the retrospective nature of the study. Also, smoking and diabetes were not included variables. All four predictors essentially speak to degree of injury severity. Interestingly, the authors did not find surgical approach, open vs. percutaneous fixation or obesity to be predictors. This is in contrast with other studies that have shown obesity to be a risk factor for complications. Overall, this was a well-conducted study with a large sample size done over a long period of time. This information will be of value to surgeons who treat these complex injuries.
Dallas
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