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What Is the Infection Rate of the Posterior Approach to Type C Pelvic Injuries?

  • Symposium: Disruptions of the Pelvic Ring: An Update
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Pelvic ring injuries with complete disruption of the posterior pelvis (AO/OTA Type C) benefit from reduction and stabilization. Open reduction in early reports had high infectious complications and many surgeons began using closed reduction and percutaneous fixation. Multiple smaller studies have reported low infection rates after a posterior approach, but these rates are not confirmed in larger series of diverse fractures.

Questions/Purposes

We therefore determined (1) the incidence of surgical site infectious complications after a posterior approach to the pelvis; and (2) whether secondary procedures other than surgical débridement are necessary as a result of the approach-related complications.

Methods

We retrospectively reviewed all 236 patients (268 surgical approaches) with C type injuries treated with a posterior approach at six institutions before 1998 and at one institution from 1998 to 2005. Posterior injuries were classified anatomically as described by Letournel and the AO/OTA system. We recorded wound complications after surgery.

Results

Surgical site infection occurred in eight of the 236 patients (3.4%) in the multicenter analysis. Treatment consisted of surgical débridement, wound closure, and antibiotics. No patients required soft tissue reconstruction as a result of the approach or infection.

Conclusion

Our data suggest with proper patient selection and the described surgical technique, there should be minimal risk for catastrophic wound complications or high infection rates as reported by others.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We acknowledge the contributions of Paul Merkle MD, Steve Olson MD, Keith Mayo MD, and David Templeman for compiling and contributing data and making this study possible.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Loyola University Medical Center, 2160 S First Avenue, Maywood, IL, 60153, USA

    Michael D. Stover MD

  2. Carolinas Medical Center, Charlotte, NC, USA

    Stephen Sims MD

  3. Hip and Pelvic Institute, Santa Monica, CA, USA

    Joel Matta MD

Authors
  1. Michael D. Stover MD
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  2. Stephen Sims MD
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  3. Joel Matta MD
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Corresponding author

Correspondence to Michael D. Stover MD.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Loyola University Medical Center, Maywood, IL, USA.

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Stover, M.D., Sims, S. & Matta, J. What Is the Infection Rate of the Posterior Approach to Type C Pelvic Injuries?. Clin Orthop Relat Res 470, 2142–2147 (2012). https://doi.org/10.1007/s11999-012-2438-9

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  • DOI: https://doi.org/10.1007/s11999-012-2438-9

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