Risk factors for fracture-related infections after low-velocity gunshot fractures to the pelvis

IF 2.2 3区 医学 Q3 CRITICAL CARE MEDICINE Injury-International Journal of the Care of the Injured Pub Date : 2024-09-24 DOI:10.1016/j.injury.2024.111918
Madelyn Coleman, Carisa Bergner, Thomas W. Carver
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Abstract

Background

Although treatments have improved dramatically in recent years, mortality following gunshot wounds (GSW) to the pelvis continue to range between 3 and 20 %. This project was designed to determine the incidence and risk factors associated with pelvic fracture-related infection (FRI) following GSWs to the pelvis given the paucity of evidence regarding this complication.

Methods

A retrospective review of 13 years (1/2010–12/2022) of patients with GSW to the pelvis was performed. Patients meeting inclusion criteria underwent chart review for the development of pelvic FRI and the following additional data elements were extracted: demographics, presence and type of bowel injury, operations performed, complications, use of postoperative antibiotics (≤24 h vs. >24 h), surgical osseous debridement, presence of retained bullet fragments, and bullet trajectory. Discrete variables were analyzed using Wilcoxon rank-sum test, chi-square, and Fischer's exact test. Pearson correlation coefficients were calculated for continuous variables.

Results

242 patients were included in the study. Concomitant bowel injury was present in 108 patients (45 %). Eleven patients (4.5 %) developed FRI, all of whom had a concomitant bowel injury (p < 0.001). Neither the presence of retained bullet fragments nor the bullet trajectory (through bowel before the bone) was associated with FRI. Antibiotic duration >24 h was not associated with a lower rate of pelvic FRI.

Conclusion

Development of FRI after a GSW to the pelvis occurs in 4.5 % of patients and is significantly associated with concomitant bowel injury, specifically colonic injury. These findings can be used to help guide further studies on the role of prophylactic antibiotics or other strategies to prevent pelvic FRI.
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骨盆低速枪击骨折后发生骨折相关感染的风险因素
背景虽然近年来治疗方法有了很大改进,但骨盆枪伤(GSW)后的死亡率仍在 3% 到 20% 之间。本项目旨在确定骨盆枪伤后骨盆骨折相关感染(FRI)的发生率和相关风险因素,因为有关这种并发症的证据很少。方法对 13 年(2010 年 1 月至 2022 年 12 月)骨盆枪伤患者进行回顾性研究。对符合纳入标准的患者进行了骨盆FRI的病历审查,并提取了以下附加数据:人口统计学特征、肠道损伤的存在和类型、所进行的手术、并发症、术后抗生素的使用(≤24 h vs. >24 h)、手术骨清创、子弹碎片残留的存在以及子弹轨迹。离散变量采用 Wilcoxon 秩和检验、卡方检验和费舍尔精确检验进行分析。对连续变量计算皮尔逊相关系数。108名患者(45%)伴有肠道损伤。11 名患者(4.5%)出现了 FRI,所有这些患者都伴有肠道损伤(p < 0.001)。残留子弹碎片的存在和子弹弹道(先穿过肠道再穿过骨头)都与 FRI 无关。结论4.5%的患者在骨盆受到 GSW 伤害后会出现 FRI,并且与同时出现的肠道损伤(尤其是结肠损伤)密切相关。这些发现有助于指导进一步研究预防性抗生素或其他策略在预防骨盆急性损伤方面的作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.00
自引率
8.00%
发文量
699
审稿时长
96 days
期刊介绍: Injury was founded in 1969 and is an international journal dealing with all aspects of trauma care and accident surgery. Our primary aim is to facilitate the exchange of ideas, techniques and information among all members of the trauma team.
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