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A review of open pelvic fractures with concurrent genitourinary injuries

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Abstract

Introduction

Open pelvic fractures (OPFs) are uncommon but potentially lethal traumatic injuries. Often caused by high energy blunt trauma, they can cause severe injury to abdominal and pelvic structures. We sought to conduct a review of the literature in order to ascertain the rates of genitourinary injury and vaginal laceration after OPF and the rates of resulting infection and mortality.

Methods

A review of PubMed was conducted to identify studies reporting the rates of genitourinary injury from OPF. Study characteristics, patient characteristics, and outcomes were collected. The data were pooled, and descriptive statistics were obtained.

Results

Eight studies encompassing 343 patients were included. Average age was 35.1 years (10–85.9), 28% were female, and the average Injury Severity Score was 26.5 (4–75). 95.5% of patients had a blunt mechanism of injury. Motor vehicle collision (23.9%), motorcycle accident (19.7%), and pedestrian struck (19.3%) were the most common etiologies. Overall mortality and infection rates were 31.2% and 18.7%, respectively. 19.7% of patients suffered an injury to the genitourinary system, and 32.4% of females sustained a vaginal laceration.

Discussion

OPFs have the potential for extremely high morbidity and mortality. While much research has been done to prevent early mortality from hemorrhage, there is comparatively little research into late mortality stemming from infection and sepsis. Intravenous antibiotics are the mainstay of treatment, and local antibiotics usage has been encouraged. In patients with a vaginal laceration, it is important to provide antibiotic coverage for vaginal flora.

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References

  1. Hermans E, Edwards MJR, Goslings JC, Biert J (2018) Open pelvic fracture: the killing fracture? J Orthop Surg Res 13:83. https://doi.org/10.1186/s13018-018-0793-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Li P, Zhou D, Fu B et al (2019) Management and outcome of pelvic fracture associated with vaginal injuries: a retrospective study of 25 cases. BMC Musculoskelet Disord 20:466. https://doi.org/10.1186/s12891-019-2839-y

    Article  PubMed  PubMed Central  Google Scholar 

  3. Cannada LK, Taylor RM, Reddix R et al (2013) The Jones-Powell classification of open pelvic fractures: a multicenter study evaluating mortality rates. J Trauma Acute Care Surg 74:901–906

    Article  PubMed  Google Scholar 

  4. Black EA, Lawson CM, Smith S, Daley BJ (2011) Open pelvic fractures: the university of tennessee medical center at knoxville experience over ten years. Iowa Orthop J 31:193–198

    PubMed  PubMed Central  Google Scholar 

  5. Fu C-Y, Huang R-Y, Wang S-Y et al (2018) Concomitant external and internal hemorrhage: challenges to managing patients with open pelvic fracture. Am J Emerg Med 36:1937–1942. https://doi.org/10.1016/j.ajem.2018.02.014

    Article  PubMed  Google Scholar 

  6. Giordano V, Koch HA, Gasparini S et al (2016) Open pelvic fractures: review of 30 cases. Open Orthop J 10:772–778. https://doi.org/10.2174/1874325001610010772

    Article  PubMed  PubMed Central  Google Scholar 

  7. Dong J, Zhou D (2011) Management and outcome of open pelvic fractures: a retrospective study of 41 cases. Injury 42:1003–1007. https://doi.org/10.1016/j.injury.2011.01.032

    Article  PubMed  Google Scholar 

  8. Dente CJ, Feliciano DV, Rozycki GS et al (2005) The outcome of open pelvic fractures in the modern era. Am J Surg 190:831–837. https://doi.org/10.1016/j.amjsurg.2005.05.050

    Article  Google Scholar 

  9. Perry JFJ (1980) Pelvic open fractures. Clin Orthop Relat Res 151:41–45

    Google Scholar 

  10. Jones AL, Powell JN, Kellam JF et al (1997) Open pelvic fractures. A multicenter retrospective analysis. Orthop Clin North Am 28:345–350. https://doi.org/10.1016/s0030-5898(05)70293-5

    Article  CAS  PubMed  Google Scholar 

  11. Young JW, Burgess AR, Brumback RJ, Poka A (1986) Pelvic fractures: value of plain radiography in early assessment and management. Radiology 160:445–451. https://doi.org/10.1148/radiology.160.2.3726125

    Article  CAS  PubMed  Google Scholar 

  12. Gustilo RB, Anderson JT (1976) Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 58:453–458

    Article  CAS  PubMed  Google Scholar 

  13. Duchesne JC, Bharmal HM, Dini AA et al (2009) Open-book pelvic fractures with perineal open wounds: a significant morbid combination. Am Surg 75:1227–1233

    Article  PubMed  Google Scholar 

  14. Siada SS, Davis JW, Kaups KL et al (2017) Current outcomes of blunt open pelvic fractures: how modern advances in trauma care may decrease mortality. Trauma Surg Acute Care Open 2:e000136. https://doi.org/10.1136/tsaco-2017-000136

    Article  PubMed  PubMed Central  Google Scholar 

  15. Richardson JD, Harty J, Amin M, Flint LM (1982) Open pelvic fractures. J Trauma 22:533–538. https://doi.org/10.1097/00005373-198207000-00002

    Article  CAS  PubMed  Google Scholar 

  16. Naam NH, Brown WH, Hurd R et al (1983) Major pelvic fractures. Arch Surg 118:610–616. https://doi.org/10.1001/archsurg.1983.01390050076015

    Article  CAS  PubMed  Google Scholar 

  17. Tseng I-C, Chen I-J, Chou Y-C et al (2020) Predictors of acute mortality after open pelvic fracture: experience from 37 patients from a level I trauma center. World J Surg 44:3737–3742. https://doi.org/10.1007/s00268-020-05675-z

    Article  PubMed  PubMed Central  Google Scholar 

  18. Mi M, Kanakaris NK, Wu X, Giannoudis PV (2020) Management and outcomes of open pelvic fractures: an update. Injury. https://doi.org/10.1016/j.injury.2020.02.096

    Article  PubMed  Google Scholar 

  19. Baker SP, O’Neill B, Haddon WJ, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196

    Article  CAS  PubMed  Google Scholar 

  20. Bolorunduro OB, Villegas C, Oyetunji TA et al (2011) Validating the Injury severity score (ISS) in different populations: ISS predicts mortality better among hispanics and females. J Surg Res 166:40–44. https://doi.org/10.1016/j.jss.2010.04.012

    Article  CAS  PubMed  Google Scholar 

  21. Hanson PB, Milne JC, Chapman MW (1991) Open fractures of the pelvis. Review of 43 cases. J Bone Joint Surg Br 73:325–329. https://doi.org/10.1302/0301-620X.73B2.2005166

    Article  CAS  PubMed  Google Scholar 

  22. Hasankhani EG, Omidi-Kashani F (2013) Treatment outcomes of open pelvic fractures associated with extensive perineal injuries. Clin Orthop Surg 5:263–268. https://doi.org/10.4055/cios.2013.5.4.263

    Article  PubMed  PubMed Central  Google Scholar 

  23. Vrahas MS, Wilson SC, Cummings PD, Paul EM (1998) Comparison of fixation methods for preventing pelvic ring expansion. Orthopedics 21:285–289

    Article  CAS  PubMed  Google Scholar 

  24. Grotz MRW, Allami MK, Harwood P et al (2005) Open pelvic fractures: epidemiology, current concepts of management and outcome. Injury 36:1–13. https://doi.org/10.1016/j.injury.2004.05.029

    Article  CAS  PubMed  Google Scholar 

  25. Giannoudis PV, Pape HC (2004) Damage control orthopaedics in unstable pelvic ring injuries. Injury 35:671–677. https://doi.org/10.1016/j.injury.2004.03.003

    Article  CAS  PubMed  Google Scholar 

  26. Marmor M, El Naga AN, Barker J et al (2020) Management of pelvic ring injury patients with hemodynamic instability. Front Surg 7:588845. https://doi.org/10.3389/fsurg.2020.588845

    Article  PubMed  PubMed Central  Google Scholar 

  27. Croce MA, Magnotti LJ, Savage SA et al (2007) Emergent pelvic fixation in patients with exsanguinating pelvic fractures. J Am Coll Surg 204:932–935. https://doi.org/10.1016/j.jamcollsurg.2007.01.059

    Article  Google Scholar 

  28. Langford JR, Burgess AR, Liporace FA, Haidukewych GJ (2013) Pelvic fractures: part 1. Evaluation, classification, and resuscitation. J Am Acad Orthop Surg 21:448–457. https://doi.org/10.5435/JAAOS-21-08-448

    Article  PubMed  Google Scholar 

  29. Moss BF, Moss CE, Dervin P et al (2020) High riding prostate: epidemiology of genitourinary injury in motorcyclists from a UK register of over 12,000 victims. Curr Urol 14:105–112. https://doi.org/10.1159/000499251

    Article  PubMed  PubMed Central  Google Scholar 

  30. Morey AF, Broghammer JA, Hollowell CMP et al (2021) Urotrauma guideline 2020: AUA guideline. J Urol 205:30–35. https://doi.org/10.1097/JU.0000000000001408

    Article  PubMed  Google Scholar 

  31. Figler BD, Hoffler CE, Reisman W et al (2012) Multi-disciplinary update on pelvic fracture associated bladder and urethral injuries. Injury 43:1242–1249. https://doi.org/10.1016/j.injury.2012.03.031

    Article  PubMed  Google Scholar 

  32. Stern N, Pignanelli M, Welk B (2019) The management of an extra peritoneal bladder injury associated with a pelvic fracture. Can Urol Assoc J 13:S56–S60. https://doi.org/10.5489/cuaj.5930

    Article  PubMed  PubMed Central  Google Scholar 

  33. Yao HH-I, Esser M, Grummet J et al (2018) Lower risk of pelvic metalware infection with operative repair of concurrent bladder rupture. ANZ J Surg 88:560–564. https://doi.org/10.1111/ans.14233

    Article  PubMed  Google Scholar 

  34. Niemi TA, Norton LW (1985) Vaginal injuries in patients with pelvic fractures. J Trauma 25:547–551. https://doi.org/10.1097/00005373-198506000-00015

    Article  CAS  PubMed  Google Scholar 

  35. Patzakis MJ, Wilkins J (1989) Factors influencing infection rate in open fracture wounds. Clin Orthop Relat Res 243:36–40

    Article  Google Scholar 

  36. Zuelzer DA, Hayes CB, Hautala GS et al (2021) Early antibiotic administration is associated with a reduced infection risk when combined with primary wound closure in patients with open tibia fractures. Clin Orthop Relat Res 479:613–619. https://doi.org/10.1097/CORR.0000000000001507

    Article  PubMed  Google Scholar 

  37. Cross WW 3rd, Swiontkowski MF (2008) Treatment principles in the management of open fractures. Indian J Orthop 42:377–386. https://doi.org/10.4103/0019-5413.43373

    Article  PubMed  PubMed Central  Google Scholar 

  38. Zalavras CG, Patzakis MJ, Holtom P (2004) Local antibiotic therapy in the treatment of open fractures and osteomyelitis. Clin Orthop Relat Res. https://doi.org/10.1097/01.blo.0000143571.18892.8d

    Article  PubMed  Google Scholar 

  39. Ostermann PA, Seligson D, Henry SL (1995) Local antibiotic therapy for severe open fractures. A review of 1085 consecutive cases. J Bone Joint Surg Br 77:93–97

    CAS  PubMed  Google Scholar 

  40. Henry SL, Hood GA, Seligson D (1993) Long-term implantation of gentamicin-polymethylmethacrylate antibiotic beads. Clin Orthop Relat Res 295:47–53

    Article  Google Scholar 

  41. Neut D, van de Belt H, van Horn JR et al (2003) Residual gentamicin-release from antibiotic-loaded polymethylmethacrylate beads after 5 years of implantation. Biomaterials 24:1829–1831. https://doi.org/10.1016/s0142-9612(02)00614-2

    Article  CAS  PubMed  Google Scholar 

  42. Fernando N, Werner S, Elhaddad M, Davies J, Firoozabadi R (2020) Do antibiotic beads need to be removed? Arch Bone Joint Surg 8(4):502. https://doi.org/10.22038/abjs.2020.44143.2208

    Article  PubMed  PubMed Central  Google Scholar 

  43. Owen MT, Keener EM, Hyde ZB et al (2017) Intraoperative topical antibiotics for infection prophylaxis in pelvic and acetabular surgery. J Orthop Trauma 31:589–594. https://doi.org/10.1097/BOT.0000000000000941

    Article  PubMed  Google Scholar 

  44. Hoff WS, Bonadies JA, Cachecho R, Dorlac WC (2011) East practice management guidelines work group: update to practice management guidelines for prophylactic antibiotic use in open fractures. J Trauma 70:751–754. https://doi.org/10.1097/TA.0b013e31820930e5

    Article  PubMed  Google Scholar 

  45. Gustilo RB, Mendoza RM, Williams DN (1984) Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 24:742–746. https://doi.org/10.1097/00005373-198408000-00009

    Article  CAS  PubMed  Google Scholar 

  46. Garner MR, Sethuraman SA, Schade MA, Boateng H (2020) Antibiotic prophylaxis in open fractures: evidence, evolving issues, and recommendations. J Am Acad Orthop Surg 28:309–315. https://doi.org/10.5435/JAAOS-D-18-00193

    Article  PubMed  Google Scholar 

  47. Larsen B, Monif GRG (2001) Understanding the bacterial flora of the female genital tract. Clin Infect Dis 32:e69–e77. https://doi.org/10.1086/318710

    Article  CAS  PubMed  Google Scholar 

  48. Duggal N, Mercado C, Daniels K et al (2008) Antibiotic prophylaxis for prevention of postpartum perineal wound complications: a randomized controlled trial. Obstet Gynecol 111:1268–1273. https://doi.org/10.1097/AOG.0b013e31816de8ad

    Article  PubMed  Google Scholar 

  49. Rotem R, Mastrolia SA, Rottenstreich M et al (2020) The use of metronidazole in women undergoing obstetric anal sphincter injuries: a systematic review of the literature. Arch Gynecol Obstet 302:321–328. https://doi.org/10.1007/s00404-020-05651-x

    Article  CAS  PubMed  Google Scholar 

  50. Suneja N, Tischler EH, Lockwood S et al (2021) Vaginal laceration in an open pelvic fracture case report: a novel, prophylactic antibiotic delivery mechanism. Case Rep Orthop 2021:5594270. https://doi.org/10.1155/2021/5594270

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, MSC 30, Brooklyn, NY, 11203, USA

    Eric H. Tischler, Adam J. Wolfert & Nishant Suneja

  2. Department of Orthopedic Surgery, New York University Langone Hospital, 150 55th Street, Brooklyn, NY, 11220, USA

    Thomas Lyon

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  1. Eric H. Tischler
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  2. Adam J. Wolfert
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EHT and AJW wrote the first draft of the manuscript. All authors reviewed and edited the manuscript and approved the final version of the manuscript.

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Correspondence to Eric H. Tischler.

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Tischler, E.H., Wolfert, A.J., Lyon, T. et al. A review of open pelvic fractures with concurrent genitourinary injuries. Eur J Orthop Surg Traumatol 33, 1515–1521 (2023). https://doi.org/10.1007/s00590-022-03388-8

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