title: Embolization of pelvic arterial injury is a risk factor for deep infection after acetabular fracture surgery.
abstract: 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.
  
  
  METHODS
  Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD 21201, USA.
authors.forename: Theodore T
authors.initials: TT
authors.lastname: Manson
authors.forename: Paul W
authors.initials: PW
authors.lastname: Perdue
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Pollak
authors.forename: Robert V
authors.initials: RV
authors.lastname: OʼToole
mesh_terms: D000077:Acetabulum / Q000293:injuries* / Q000601:surgery*; D001158:Arteries / Q000293:injuries*; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology*