Does anterior plating of pelvic ring fractures increase infection risk in patients with bladder or urethral injuries?

Abstract

OBJECTIVES: Evaluate the effect of anterior fixation on infection in patients with operative pelvic fractures and bladder or urethral injuries. METHODS: Design: Retrospective Setting: Eight centers Patient Selection Criteria: Adult patients with closed pelvic fractures with associated bladder or urethral injuries treated with anterior plating (AP), intramedullary screw (IS) or no anterior internal fixation (NAIF, including external fixation or no fixation) Outcome Measures and Comparisons: Deep infection RESULTS: There were 81 extraperitoneal injuries and 57 urethral injuries. There was no difference in infection between fixation groups across all urologic injuries (AP: 10.8%, IS: 0%, NAIF: 4.9%, p = 0.41). There was a higher rate of infection in the urethral injury group compared to extraperitoneal injuries (14.0% vs 2.5%, p = 0.016). Among extraperitoneal injuries specifically, there was no difference in deep infection related to fixation (AP: 2.6%, IS 0%, NAIF: 2.9%, p = 0.99). Among urethral injuries, there was no statistical difference in deep infection related to fixation (AP: 23.1%, IS: 0%, NAIF: 7.4%, p = 0.21). There was a higher rate of suprapubic catheter (SPC) use in urethral injuries compared to extraperitoneal injuries (57.9% vs 4.9%, p < 0.0001). In the urethral injury group, SPC use did not have a statistically significant difference in infection rate (SPC: 18.2% vs No SPC: 8.3%, p = 0.45). Early removal of the SPC before or during the definitive orthopedic intervention did not significantly effect infection rate (Early: 0% vs Delayed: 25.0%, p = 0.16). CONCLUSIONS: Surgeons should approach operative pelvic fractures with associated urologic injuries with caution given the high risk of infection. Further work must be done to elucidate the effect of anterior implants and suprapubic catheter use and duration.