Risk Factors Associated With Pelvic Osteomyelitis After Penetrating Trauma
*Madelyn Coleman, *Carisa Bergner, *Thomas Carver
Medical College of Wisconsin, Milwaukee, WI
OBJECTIVE: This project was designed to determine the incidence and risk factors associated with pelvic osteomyelitis following gunshot wounds (GSW) to the pelvis.
METHODS: Using the trauma registry, eleven years of patients (3/2010 – 3/2021) were screened for GSW to the pelvis. Patients meeting inclusion criteria underwent chart review for the development of osteomyelitis and the following data elements were extracted: demographics, presence/type of bowel injury, operations performed, use of antibiotics, whether surgical debridement was performed, and if retained bullet fragments were present. Discrete variables were analyzed using chi-square or Fischer’s exact test, where appropriate. Pearson correlation coefficients were calculated for continuous variables.
RESULTS: Two-hundred four patients were identified from the registry. Males were 85% of the entire cohort and the average age was 29.8 years. Concomitant bowel injury was present in 95 patients (46%). Nine patients (4.4%) developed osteomyelitis with an average of 146 days to diagnosis. All nine had a concomitant bowel injury (p < 0.001). Bone debridement was significantly associated with osteomyelitis development (p = 0.04) as was older age (36.9 vs 29.8 years, p = 0.03). Neither use of antibiotics >24 hours, retained bullet fragments, tobacco use, or BMI were associated with osteomyelitis.
CONCLUSION: Development of osteomyelitis after GSW to the pelvis was significantly associated with age and concomitant bowel injury. We did not find antibiotics or debridement to be protective and debridement may actually be harmful. These findings are limited because of their retrospective nature but can be used to design a multi-center trial to further explore the gaps around the role of prophylactic antibiotics or other strategies to prevent this complication.
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