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Treatment of Fracture-Related Infection after Pelvic Fracture
Viola Freigang1,2, Nike Walter1, Markus Rupp1
1Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
Background:
The management of pelvic fractures is a significant challenge. Surgical site infection can result in the need for revision surgery, cause functional impairment, and lead to a prolonged length of stay and increased treatment costs. Although reports on fracture-related infection (FRI) after pelvic fracture fixation are sparsely reported in the literature, it is a serious complication. This study analysed patients with FRIs after pelvic fracture regarding patient characteristics, treatment strategies, and an evaluation of risk factors for FRI.
Methods:
In this retrospective single-centre study, FRI was diagnosed based on clinical symptoms of infection and a positive culture of a bacterial infection. Depending on the severity and acuteness of the infection, osseous stabilization was restored either via implant retention (stable implant, no osteolysis), exchange (loose implant or bony defect), or external fixation (recurrence of infection after prior implant retaining revision). Healing of infection was defined as no sign of recurring infection upon clinical, radiological, and laboratory examination in the last follow-up visit.
Results:
The FRI rate in our patient population was 7.5% (24/316). In 8/24 patients, the FRI occurred within the first three weeks after initial surgery (early) and 16/24 presented with a late onset of symptoms of FRI. A strategy of debridement, antibiotics, and implant retention (DAIR) was successful in 9/24 patients with FRI after pelvic fracture. A total of 10 patients required an exchange of osteo-synthetic implants, whereof three were exchanged to an external fixator. In five patients, we removed the implant because the fracture had already consolidated at the time of revision for infection. A total of 17/24 patients had a poly-microbial infection after a pelvic fracture and 3/24 patients died from post-traumatic multi-organ failure within the first 6 months after trauma. There were no cases of persistent infection within the remaining 21 patients.
Conclusions:
Although poly-microbial infection is common in FRI after pelvic fracture, the recurrence rate of infection is relatively low. A complex pelvic trauma with significant soft tissue injury is a risk factor for recurrent infection and multiple revisions. A strategy of DAIR can be successful in patients with a stable implant. In cases with recurrent infection or an unstable fracture site, the exchange of implants should be considered.
Insights
Fracture-related infection (FRI) after pelvic fracture fixation affects 7.5% of patients. While poly-microbial infections are common, recurrence rates are low, with debridement, antibiotics, and implant retention (DAIR) showing success in stable cases.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Management
- Trauma Care
Background:
- Pelvic fractures pose significant management challenges.
- Surgical site infections (SSIs) following pelvic fracture fixation lead to adverse outcomes, including revision surgery, functional impairment, prolonged hospitalization, and increased costs.
- Fracture-related infection (FRI) is a serious complication, though sparsely reported in pelvic fracture literature.
Purpose of the Study:
- To analyze patient characteristics, treatment strategies, and risk factors associated with fracture-related infections (FRIs) after pelvic fracture fixation.
- To evaluate the outcomes of different management strategies for FRI in pelvic fractures.
- To identify factors contributing to recurrent infections and the need for revision surgery.
Main Methods:
- Retrospective single-center study analyzing patients diagnosed with FRI based on clinical symptoms and positive bacterial cultures.
- Classification of FRI onset as early (within 3 weeks) or late (>3 weeks) post-surgery.
- Treatment strategies included debridement, antibiotics, and implant retention (DAIR), implant exchange, or external fixation, with healing defined by absence of recurring infection signs.
Main Results:
- The overall FRI rate was 7.5% (24/316 patients).
- Early onset FRI occurred in 8/24 patients, and late onset in 16/24.
- DAIR was successful in 9/24 patients; 10 patients required implant exchange, and 5 had implants removed due to fracture consolidation. Seventeen patients had polymicrobial infections; 3 died from multi-organ failure. No persistent infections were observed in the remaining 21 patients.
Conclusions:
- Poly-microbial infections are frequent in pelvic fracture-related infections, but recurrence rates are relatively low.
- Complex pelvic trauma with significant soft tissue injury is identified as a risk factor for recurrent infection and multiple revisions.
- DAIR is a viable strategy for stable implants, while implant exchange is recommended for recurrent infections or unstable fracture sites.
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