Determine the infection risk of nonoperative versus operative repair of extraperitoneal bladder ruptures in patients with pelvic ring injuries.
Pelvic ring injuries with extraperitoneal bladder ruptures were identified from a prospective trauma registry at two level 1 trauma centers from 2014 to 2020. Patients, injuries, treatments, and complications were reviewed. Using Fisher's exact test with significance at P value < 0.05, associations between injury treatment and outcomes were determined. Of the 1127 patients with pelvic ring injuries, 68 (6%) had a concomitant extraperitoneal bladder rupture. All patients received IV antibiotics for an average of 2.5 days. A suprapubic catheter was placed in 4 patients. Bladder repairs were performed in 55 (81%) patients, 28 of those simultaneous with ORIF anterior pelvic ring. The other 27 bladder repair patients underwent initial ex-lap with bladder repair and on average had pelvic fixation 2.2 days later. Nonoperative management of bladder rupture with prolonged Foley catheterization was used in 13 patients. Improved fracture reduction was noted in the ORIF cohort compared to the closed reduction external fixation cohort (P = 0.04). There were 5 (7%) deep infections. Deep infection was associated with nonoperative management of bladder rupture (P = 0.003) and use of a suprapubic catheter (P = 0.02). Not repairing the bladder increased odds of infection 17-fold compared to repair (OR 16.9, 95% CI 1.75 – 164, P = 0.01). Operative repair of extraperitoneal bladder ruptures substantially decreases risk of infection in patients with pelvic ring injuries. ORIF of anterior pelvic ring does not increase risk of infection and results in better reductions compared to closed reduction. Suprapubic catheters should be avoided if possible due to increased infection risk later. Treatment algorithms for pelvic ring injuries with extraperitoneal bladder ruptures should recommend early bladder repair and emphasize anterior pelvic ORIF.
We report on a patient with an unusual pulmonary infection after resection of a high-grade osteosarcoma. In March 2007 a 30-year old female with pain and swelling of the left proximal humerus was submitted to the orthopaedic department. Rx and CT revealed a tumour with destruction and invasion of the surrounding soft tissue. Incision biopsy led to the diagnosis of osteoblastic osteosarcoma. She was enrolled into the EURAMOS protocol and received neoadjuvant chemotherapy. In July 2007 an extra-articular resection of the proximal humerus with modular endoprosthetic replacement was performed. The sarcoma had responded well to chemotherapy (regression grade 3 according to Salzer-Kunts-chik). Surprisingly, the resection specimen demonstrated a “skip lesion” of vital sarcoma in the resection line not been detected by preoperative PET or MRT. After consultation of the German study group she was stratified into the standard risk group. 12 months later a control CT revealed multiple foci in both lungs, which were highly suspicious for pulmonary metastases. All clinical parameters were normal. A lung biopsy was performed by thoracotomy and a granulomatous infection was diagnosed, which was suspicious for tuberculosis. Extended microbiological investigations by culture and PCR analysis revealed an infection by Myco-bacterium Xenopi, which is a rare form of an atypical mycobacteriosis. Since then she is treated accordingly, however the infection has progressed and involvement of the liver has been diagnosed by cutting needle biopsy.
In our outpatient clinic we have assessed the clinical follow-up as clinical examination (Enneking-score) and standardized radiological follow-up for 5 years, then once per year. In the focus of interest were aseptic loosening of the stems, wear of polyethylene, and mechanical problems as implant failure
We conclude that in tumour patients with major osseous reconstruction after wide resection a certain loss ob function cannot be avoided, but the rate of complications in the long-term-follow-up after implantation of modular tumour prosthesis is acceptable.