PAPER 123: THE TREATMENT OF PELVIS FRACTURES WITH ASSOCIATED UROLOGICAL INJURY: DOES THE TYPE OF FIXATION INFLUENCE THE RISK OF COMPLICATIONS?

Abstract

Purpose: The management of pelvic fractures with urinary disruption is controversial, with potential cotamination of anterior ORIF by bladder or urethral injuries and possible deep infection and non-union. External fixation is advocated by some to avoid such problems, on theoretical grounds of limited soft tissue disruption. This advantage however has not been clearly substantiated. The purpose of this study is to describe the epidemiology of these injuries and to compare the risk of deep wound infection in patients with pelvic fractures and urinary disruption treated with ORIF versus External Fixation (EF).

Method: Retrospective review of prospectively collected data on patients treated at a tertiary trauma centre between 1999 and 2006. Demographics, Injury charateristics, Treatment and Outcomes (infection, non-union) of adults sustaining pelvic fractures with associated urinary disruption and treated by ORIF or EF were analysed. Of the 444 pelvis fractures operated over that period, 78 cases had an associated urological injury. Mean age 35 (SD13), ISS 28 (SD10), sex: 65% male, 35% female, AO/OTA #type: A 3.8%, B 48.7%, C 47.4%, 13 Open fractures (17%), Urological injuries: 64% Bladder, 22% urethra, 6% combined bladder-urethra, 8% associated pelivc organ injury. Treatment was ORIF in 49 (63%) and EF in 29 (37%).

Results: ORIF and EF groups showed no statistically significant difference (p values indicated) in: Age (.07) and ISS (.22) by T-test, or Fracture type (.92), Gustilo classification (.08), Urological injury (.11) by Chi Sq. Early Deep wound infection occurred in 2 of 48 (4.1%) ORIF cases, and in 1 of 29 (3.4%) in EF cases. The differences were not statitically significant. (Chi Sq). There were no nonunion cases and no late deep wound infection in either group. The infection rate was however significantly different than in the entire pelvis frature cohort of 433 cases, which is 0.9%.

Conclusion: External fixation showed no advantage with respect to infection rate, with the rate of deep infection in both ORIF and EF showing no statistically significant difference. Despite its statistical power limitations, this study assembles the largest cohort with this comibination of injuries and guides the orthopedic surgeon in his or her treatment decisions.