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Does colostomy prevent infection in open blunt pelvic fractures? A systematic review
Karl Lunsjo1, Fikri M Abu-Zidan
1Department of Surgery, UAE University, Al Ain, United Arabic Emirates.
Insights
The use of diverting colostomy for open pelvic fractures lacks strong evidence. Current literature shows no significant difference in infection rates, highlighting the need for further research.
Area of Science:
- Trauma Surgery
- Orthopedic Surgery
- Surgical Outcomes
Background:
- Open pelvic fractures are uncommon injuries.
- Infection prevention is a key concern in managing these fractures.
- The role of diverting colostomy in preventing infection remains unclear.
Purpose of the Study:
- To systematically review existing literature.
- To determine indications for diverting colostomy in open blunt pelvic fractures.
- To assess the effectiveness of colostomy in reducing infection.
Main Methods:
- Comprehensive literature search of MEDLINE and PubMed.
- Inclusion of studies on open pelvic fractures and colostomy use.
- Critical appraisal of study methodologies and findings.
Main Results:
- The evidence supporting colostomy use is of very low quality.
- Retrospective studies without statistical analysis dominate the literature.
- No significant difference in infectious complication rates was observed between groups.
Conclusions:
- The necessity and efficacy of colostomy in open blunt pelvic fractures are not established.
- Randomized multicenter trials are required to resolve the role of colostomy.
- Further research should clarify indications, particularly concerning rectal involvement.
Background:
Open pelvic fracture is a rare injury. Our aim in this study is to systematically review the literature to define when diverting colostomy is indicated to protect the patient from infection in open blunt pelvic fractures.
Methods:
Papers studying open pelvic fractures and the use of colostomy were retrieved through MEDLINE and PUBMED. The papers were critically appraised regarding their methodology and conclusions. Relevant information was combined.
Results:
The level of evidence for the use of colostomy in open pelvic fractures is very low. All reports are retrospective and no statistical methods have been used to support conclusions drawn. We found no difference in the overall infectious complication rate between the colostomy and noncolostomy groups. There is an assumption that patients with perineal wounds would benefit from colostomy; however, rectal involvement in these injuries was not detailed.
Conclusion:
The role of colostomy in open blunt pelvic fractures is unresolved and randomized multicenter trials are needed.
