Review Question - QID 8981

From the following options, only obesity has been shown to be associated with a statistically higher incidence of wound complications following pelvic and acetabular fracture fixation for trauma.

Wound complications following pelvic and acetabular fracture fixation is relatively uncommon. Literature suggests and prevalence of 2-8% with closed fracture injuries. Factors shown to increase infection rates include both patient and surgical factors. They include obesity, diabetes, immunocompromised, elderly, pre-operative embolization and open fractures.

Sagi et al. looked at the factors contributing to wound infection after pelvic and acetabular surgery. Open pelvic or acetabular fractures were excluded. Of all the factors, only obesity (OR 8, PPV 33%), obesity plus leukocytosis (OR 12, PPV 39%), and preoperative angioembolization (OR 11, PPV 67%) were strong predictors of postoperative infection.

Manson et al. aimed to determine if embolization of pelvic arterial injuries before open reduction and internal fixation (ORIF) of acetabular fractures is associated with an increased rate of deep surgical site infection. They retrospective reviewed 1440 patients who underwent ORIF of acetabular fractures. They found a 58% infection rate of the patients who underwent embolization before ORIF vs, historical controls (2%-5%) and angiography without embolization (14%).

Figure A shows an AP radiograph and 3D CT reconstruction of a APC3 pelvic ring fracture.

Incorrect Answers:
Answer 1: Head injury has not been shown to increase infection rates. It has been shown to increase heterotrophic ossification.
Answer 3: Gender has not shown to increase infection rates
Answer 4: Early surgery has not been shown to affect infection rates.
Answer 5: Transfer from an outside facility has not been shown to affect infection rates.