Highlights
- •Having concomitant pelvic ring injuries and genitourinary injuries resulted in an increase rate of post operative complications.
- •Timing of surgical intervention was not associated with post operative complications.
- •Medical co-morbidities, age, injury severity score, length of stay were not associated with an increased post operative complication rate.
Abstract
Objective
Pelvic ring injuries are often associated with vascular and intrapelvic organ injuries
including damage to the genitourinary system. The purpose of this study was to examine
the relationship between surgically treated pelvic ring injuries and genitourinary
injuries. The primary outcome was to determine the rate of post-operative complications
including infection, urinary dysfunction, and sexual dysfunction. The secondary outcome
was to determine if the time to surgery was associated with post-operative complications.
Methods
Retrospective chart review from September 1, 2015 to December 31, 2019 of patients
who sustained a pelvic ring injury which required surgical intervention. All patients
with closed triradiate cartilage were included.
Results
A total of 115 patients met the inclusion criteria, 12 patients with an associated
genitourinary (GU) injury were included in the GU group and 103 without GU injury
were placed in the non-GU group. The median (range) age of patients in the GU group
was 49.5 years (20, 64) and 48 years (15, 92) in the control group (p=0.92). Demographic
characteristics including age, Injury Severity Score and Elixhauser comorbidity score
were similar between groups. Within the GU group, five patients had an injury to their
bladder, four to their urethra and three had an injury to their kidney. In the GU
group, one patient developed a wound dehiscence and one developed a urinary tract
infection with subsequent sepsis (17%), while in the non-GU group, one patient (1%)
developed erectile dysfunction (p=0.028). Regression analysis demonstrated that having
concomitant pelvic ring and GU injuries, as well as the number of surgeries were variables
associated with post-operative complications, while time to surgery was not.
Discussion and Conclusions
Pelvic ring injuries with concomitant genitourinary injuries were associated with
increased odds of post-operative complications. No differences were noted in complication
rates due to the time to surgery between groups.
Keywords
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References
- The Human Pelvis: Variation in Structure and Function During Gait.Anat Rec. 2017; 300: 633-642https://doi.org/10.1002/ar.23552
- The epidemiology of pelvic ring fractures: A population-based study.J Trauma - Inj Infect Crit Care. 2007; 63: 1066-1072https://doi.org/10.1097/TA.0b013e3181589fa4
- A Nationwide Analysis of Pelvic Ring Fractures.Geriatr Orthop Surg Rehabil. 2016; 7: 9-17https://doi.org/10.1177/2151458515616250
- Management and outcomes of open pelvic fractures: An update.Injury. 2021; 52: 2738-2745https://doi.org/10.1016/j.injury.2020.02.096
- The Longitudinal Short-, Medium-, and Long-Term Functional Recovery After Unstable Pelvic Ring Injuries.J Orthop Trauma. 2019; 33: 608-613https://doi.org/10.1097/BOT.0000000000001588
- Multi-disciplinary update on pelvic fracture associated bladder and urethral injuries.Injury. 2012; 43: 1242-1249https://doi.org/10.1016/j.injury.2012.03.031
- The Open Blast Pelvis The Significant Burden of Management.J BONE Jt Surg. 2012; 94: 829-835https://doi.org/10.1302/0301-620X.94B6.28359
- Pelvic Fractures : Soft Tissue Trauma.Eur J Trauma Emerg Surg. 2010; : 117-123https://doi.org/10.1007/s00068-010-1038-0
- Pelvic fracture and associated urologic injuries.World J Surg. 2001; 25: 1578-1587https://doi.org/10.1007/s00268-001-0153-x
- Pelvic fracture urethral injuries: The unresolved controversy.J Urol. 1999; 161: 1433-1441https://doi.org/10.1016/S0022-5347(05)68918-5
- A modification of the elixhauser comorbidity measures into a point system for hospital death using administrative data.Med Care. 2009; 47: 626-633https://doi.org/10.1097/MLR.0b013e31819432e5
- Discriminative Ability for Adverse Outcomes after Surgical Management of Hip Fractures: A Comparison of the Charlson Comorbidity Index, Elixhauser Comorbidity Measure, and Modified Frailty Index.J Orthop Trauma. 2018; 32: 231-237https://doi.org/10.1097/BOT.0000000000001140
- Predicting in-hospital mortality in elderly patients with cervical spine fractures: A comparison of the charlson and elixhauser comorbidity measures.Spine (Phila Pa 1976). 2015; 40: 809-815https://doi.org/10.1097/BRS.0000000000000892
- A Comparison of the Charlson and Elixhauser Comorbidity Measures to Predict Inpatient Mortality after Proximal Humerus Fracture.J Orthop Trauma. 2015; 29: 488-493https://doi.org/10.1097/BOT.0000000000000380
- Predicting In-Hospital Complications After Anterior Cervical Discectomy and Fusion: A Comparison of the Elixhauser and Charlson Comorbidity Indices.World Neurosurg. 2020; 134: e487-e496https://doi.org/10.1016/j.wneu.2019.10.102
- Predicting adverse events, length of stay, and discharge disposition following shoulder arthroplasty: a comparison of the Elixhauser Comorbidity Measure and Charlson Comorbidity Index.J Shoulder Elb Surg. 2018; 27: 1748-1755https://doi.org/10.1016/j.jse.2018.03.001
- Comorbidity Measures for Use with Administrative Data.Med Care. 1998; 36: 8-27https://doi.org/10.1097/00005650-199801000-00004
- Risk of infectious complications in pelvic fracture urethral injury patients managed with internal fixation and suprapubic catheter placement.J Trauma Acute Care Surg. 2018; 85: 536-540https://doi.org/10.1097/TA.0000000000002012
- Team approach: Evaluation and management of pelvic ring injuries.JBJS Rev. 2020; 8: 1-9https://doi.org/10.2106/JBJS.RVW.19.00149
- Internal fixation in pelvic fractures and primary repairs of associated genitourinary disruptions: a team approach.J Trauma. 1996; 40: 784-790https://doi.org/10.1097/00005373-199605000-00018
- Urologic injuries in pelvic ring disruptions.Clin Orthop Relat Res. 1996; 4: 37-45https://doi.org/10.1097/00003086-199608000-00006
- Morbidity associated with nonoperative management of extraperitoneal bladder injuries.J Trauma. 1995; 38: 895-898https://doi.org/10.1097/00005373-199506000-00012
- Epidemiology of Blunt Lower Urinary Tract Trauma With and Without Pelvic Fracture.Urology. 2017; 102: 234-239https://doi.org/10.1016/j.urology.2016.11.015
- Risk factors and mechanism of urethral injury in pelvic fractures.Br J Urol. 1996; 77: 876-880https://doi.org/10.1046/j.1464-410x.1996.01119.x
- Fracture locations influence the likelihood of rectal and lower urinary tract injuries in patients sustaining pelvic fractures.J Trauma. 2002; 52: 205-209https://doi.org/10.1097/00005373-200202000-00001
- The Jones-Powell classification of open pelvic fractures: A multicenter study evaluating mortality rates.J Trauma Acute Care Surg. 2013; 74: 901-906https://doi.org/10.1097/TA.0b013e3182827496
- Concomitant external and internal hemorrhage: Challenges to managing patients with open pelvic fracture.Am J Emerg Med. 2018; 36: 1937-1942https://doi.org/10.1016/j.ajem.2018.02.014
- Proposed mechanisms of lower urinary tract injury in fractures of the pelvic ring.BJU Int. 2007; 100: 567-573https://doi.org/10.1111/j.1464-410X.2007.07020.x
- The outcome of open pelvic fractures in the modern era.Am J Surg. 2005; 190: 831-837https://doi.org/10.1016/j.amjsurg.2005.05.050
- Predictors of unplanned reoperation after operative treatment of pelvic ring injuries.J Orthop Trauma. 2018; 32: E245-E250https://doi.org/10.1097/BOT.0000000000001170
- Open pelvic fractures: A multicenter retrospective analysis.Orthop Clin North Am. 1997; 28: 345-350https://doi.org/10.1016/S0030-5898(05)70293-5
Article info
Publication history
Accepted:
January 16,
2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd. All rights reserved.
