Research disputes link between infection, catheter placement after injury

Adding new data to the controversy involving urology and orthopedics, a review of trauma-associated posterior urethral distraction injury revealed a post-treatment infection rate of 8.8% in men who received suprapubic catheters with orthopedic intervention for pelvic fractures.

Three of 34 patients developed postoperative infections following orthopedic surgery and placement of suprapubic catheters for management of urethral distraction. This rate falls within the range of 3% to 20% previously reported in the literature.

"We hope in the future to have a large, multicenter collaboration to further elucidate the risk of infection in this patient population to the ultimate goal of improving outcomes in trauma patients," said first author Jennifer Bepple, MD, working with Gerald Jordan, MD, at Eastern Virginia University, Norfolk.

Initial urologic intervention after pelvic fracture remains controversial, although most patients receive a suprapubic catheter. However, concern about an anecdote-driven risk of infection makes some orthopedic surgeons hesitant to manage pelvic fractures by fixation if a suprapubic catheter is placed, said Dr. Bepple.

Investigators retrospectively reviewed cases of pelvic fracture involving orthopedic intervention and placement of a suprapubic catheter that occurred between 1992 and 2006. The 34 cases comprised 22 motor vehicle accidents and 12 pelvic crush injuries, all involving male patients. Fifteen patients underwent external fixation, 15 underwent open reduction and internal fixation, and the remaining four patients underwent both types of procedures.

The three postoperative infections consisted of a pelvic abscess, osteomyelitis of the femur, and an infection of the iliac crests. Because of the small number of patients, no conclusions could be drawn about the relative risk of infection associated with internal versus external fixation procedures, Dr. Bepple said.