Objective: To determine whether embolization of pelvic arterial injuries before open reduction and internal fixation (ORIF) of acetabular fractures is associated with an increased rate of deep surgical site infection.
Methods: Retrospective review of patients who underwent ORIF of acetabular fractures at our institution from 1995 through 2007 (n = 1440). We compared patients with acetabular fractures who underwent angiography and embolization of a pelvic artery (n = 12) with those who underwent angiography but did not undergo embolization (n = 14). Primary outcome was presence of infection requiring return to the operating room.
Results: Seven (58%) of the 12 patients who underwent embolization developed deep surgical site infection compared with only 2 (14%) of the patients who underwent angiography but did not require pelvic vessel embolization (P < 0.05, Fisher exact test).
Conclusions: The combination of an acetabular fracture that requires ORIF and a pelvic arterial injury that requires angiographic embolization is rare. However, the 58% infection rate of the patients who underwent embolization before ORIF is an order of magnitude higher than typical historical controls (2%-5%) and significantly higher than that of the control group of patients who underwent angiography without embolization (14%). In addition, a disproportionate number of the patients who developed infection had their entire internal iliac artery embolized. Surgeons should be aware that embolization of a pelvic arterial injury is associated with a high rate of infection after subsequent ORIF of an acetabular fracture. Embolization of the entire iliac artery should be avoided whenever possible.
Level of evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.