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Ballistic Pelvic Fractures With Bowel-First Trajectory Are Associated With Increased Rates of Bony Infection: A
Andrew P Collins1,2, Loren O Black1,2, Jessica Porras3
1Department of Orthopaedic Surgery and Sports Medicine, University of Washington, Seattle, WA.
Journal of Orthopaedic Trauma
|January 22, 2026
Summary
Ballistic ilium fractures where the bullet path goes through the bowel before bone increase deep infection risk. Early bony debridement may be crucial for these complex pelvic injuries.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
- Infectious Disease
Background:
- Ballistic ilium fractures present complex challenges in trauma care.
- Understanding infection risks associated with projectile trajectories is critical for patient outcomes.
Purpose of the Study:
- To compare deep infection rates in ballistic ilium fractures based on projectile trajectory.
- To identify factors associated with deep infection in bony pelvis injuries.
Main Methods:
- Retrospective cohort study across eight Level I trauma centers.
- Included patients (≥18 years) with ballistic ilium fractures (OTA/AO 61) and 6-month follow-up.
- Analyzed trajectory (bowel before bone vs. bone before bowel) using CT scans and multivariable logistic regression.
Main Results:
- 201 patients analyzed; 41% had bowel-before-bone trajectory.
- Bowel-before-bone cohort showed higher Injury Severity Score and increased deep infection rates (10.8% vs. 1.4%).
- Bullet trajectory traversing bowel before bone significantly associated with deep infection (OR 14.6, p=0.021).
Conclusions:
- Ballistic ilium fractures with bowel trajectory involvement have higher deep infection rates.
- Further research is needed on the role of acute bony irrigation and debridement in these cases.
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