Experience in treatment of pelvic fractures in multiple and associated injuries

Abstract

Materials and and methods: We present treatment results of 623 polytrauma patients with pelvic fractures. There were 411 (66,53%) males and 212 females (33,47%), mean age 37,59±1,001 years (p<0,05). The main cause of trauma was traffic road accident (64,37%), fall from height (25,32%), high energy impact (10,31%). All the patients were complex examined, pelvic fractures were detected according to M.Tile classification. Stabilizing pelvis osteosynthesis by device for external fixation was performed in 52 cases as an antishock measure. Early pelvis osteosynthesis was done in 172 patients for quick mobilization. Other patients underwent delayed osteosynthesis after 7 days, open reduction and combined osteosynthesis was performed in 12 cases. Results: Pelvic fractures type B and C leveled to type A after osteosynthesis by external device. Patient hemodynamic was stabilized. Volume of transfusions decreased, on average, for one patient at 1,2 ± 0,2 l/day, blood products – at 0,68±0,2 l/day (p<0,05). Enlargement of the radiological shadow, the "blurring" of the iliac muscle contours, development of the intenstinal paresis was not observed. All these signs proved the tanpmade effect of eraly pelvis osteosynthesis. Vertical mobilization of the patients with urinary bladder injuries led to normalization of the urine passage and its composition. External fixation of the polyfocal and rotational unstable pelvic fractures allowed one-step and dosage correction of the pelvic ring and prevented developement of complications. Vertical displacement of the hemipelvis was eliminated by creating of the additional support point up to optimal correction of the bone fragments, and saving the patient mobility. Conclusions: Elaborated surgical treatment of the pelvic injuries, management of the polytrauma patients resulted in positive outcomes in 97,4%. Adequate surgical correction of the pelvis is possible almost in all the cases. The positive effect of pelvic stabilization by device for external fixation is especially expressed in the resuscitation period. Device for reposition and external fixation allows stable fixation of the bone fragments in different clinical situations, maintains movements in the hip joints and helps restoring the function of pelvic organs, cardiovascular and respiratory systems.