R. J. Miskimins1, M. Decker2, T. R. Howdieshell1, S. W. Lu1, S. D. West1 1University Of New Mexico HSC,Department Of Surgery,Albuquerque, NM, USA 2University Of New Mexico HSC,Department Of Orthopedic Surgery,Albuquerque, NM, USA
Introduction: Approximately 50% of blunt trauma cases with pelvic fractures have associated intraabdominal trauma. Fixation of the anterior pelvis may be performed by open reduction and internal fixation (ORIF) or external fixation (Ex-fix). The approach to ORIF in patients who have undergone laparotomy is often through extension of the laparotomy incision. However, a review of the literature shows no recent articles pertaining to timing or method of anterior pelvic ring fixation with recent laparotomy. The optimal method for fixation in these patients is not known. We hypothesized that ORIF performed through extension of the midline laparotomy incision would result in a clinically relevant difference in rates of wound closure and wound complications versus external fixation.
Methods: We identified all patients admitted from 2004 to 2014 who underwent laparotomy and ORIF of their anterior pelvic ring through extension of the laparotomy incision or Ex-fix of the anterior pelvic ring. A retrospective review was performed. Injury Severity Score (ISS); age; length of stay; the rates of ventral hernia, abdominal wound infection, pelvic abscess; number of units transfused; presence of bowel or bladder injury; additional operative or interventional procedures performed related to any complication were collected. The continuous variables were analyzed using the Mann Whitney U test and Fisher’s exact test was used to determine statistical significance of categorical data.
Results:A total of 34 patients were identified from January 2004 to April 2014 who underwent exploratory laparotomy and pelvic fixation, 21 underwent external fixation of the anterior pelvic ring while 13 underwent open reduction internal fixation of the anterior pelvic ring by extending the midline laparotomy incision. There was no difference in the ISS, length of stay, age, units of blood products transfused, bowel injury, or bladder injury between the two groups. The two groups had a similar incidence of ventral hernia (38% vs. 19%, p =0.254); however, the ORIF group were significantly more likely to have a laparotomy incision infection (54% vs. 5%, p=0.002), pelvic abscess (46% vs. 10%, p= 0.033) and need for additional procedures to address their complications (13 vs. 6, p=0.023). We did note a significantly higher BMI (32.5 vs. 27.2, p=0.023) in the ORIF group which could be a confounding factor contributing to the increase in wound complications.
Conclusion:Individuals who have undergone laparotomy and fixation of their anterior pelvic ring are a complex group of patients. They have high ISS, long hospitals stays and multiple injuries. The ORIF group experienced significantly higher rates of laparotomy incision infections, pelvic abscesses and required more procedures to manage these complications. These data suggest careful consideration of the method of anterior pelvic ring fixation in patients who also undergo laparotomy.