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Year 2016 Vol. 24 No 6

REVIEWS

V.S. KOZOPAS

CURRENT TECHNIQUES AND METHODS OF THE TREATMENT OF PELVIC FRACTURES

Danylo Halytsky Lviv National Medical University,
Lviv,
Ukraine

In recent decades, the problem of injuries in general and the pelvic damages in particular, including multiple and combined injuries, remains one of the most urgent not only in traumatology and orthopedics, but also in other fields of surgery, as well as reanimatology and health organization. Analyzing polytrauma structure the pelvic damages are observed in 17-39% of cases. Despite such frequent verification of pelvic injuries, conservative and surgical treatment of this disease does not always lead to positive results. In the case of combined pelvic injuries mortality may reach up to 80%, among the patients who have undergone pelvic injury the invalids became up to 50%.
The literature review on the diagnosis and treatment of pelvic fractures permits to inform the specialists, dealing with this issue, about current classification of pelvic fractures along with the standards of examination, treatment, principles of medical evacuation and optimization of medical aids orientated on patients with pelvic ring fractures. It is shown, that providing emergency care to the victims with pelvic injuries, especially with multiple and combined trauma at the prehospital and hospital stages, requires the development of techniques that are effective for pain control, the administration of anti-shock fluids at the accident site, creating unified facilities of immobilization, as well as the revision of organization of medical care providing in these cases.

Keywords: fractures of the pelvis, polytrauma, victims, immobilization, accident site, method of treatment, prehospital and hospital stages
p. 601-609 of the original issue
References
  1. Bitchuk DD, Kovalev SI, Istomin AG, Chaienko VP, Fadeev OP. Vneochagovyi osteosintez taza pri politravme [Extrafocal pelvis osteosynthesis in polytrauma]. Ortopediia Travmatologiia i Protezirovanie. 1996;(2):48-50.
  2. Ushakov SA, Lukin SIu, Istokskii KN, Nikol'skii AV, Mitreikin IuV. Lechenie travmy taza, oslozhnennoi povrezhdeniiami urogenital'nogo trakta [Treatment of pelvic trauma complicated by lesions of the urogenital tract]. Genii Ortopedii. 2011;(1):140-44.
  3. Batpenov ND. Baimagambetov ShA, Makhambetchin MM. Raneniia kishki oskolkom kosti pri nestabil'nykh perelomakh taza u bol'nykh s politravmoi [Wound gut bone splinter when the unstable pelvic fractures in patients with multiple injuries]. Travmatologiia i Ortopediia Rossii. 2011;62(4):100-104.
  4. Chemiris AI, Nerianov IuM, Kudievskii AV, i dr. Oshibki i nedostatki pri okazanii pervoi meditsinskoi pomoshchi postradavshim s politravmoi na dogospital'nom etape [Mistakes and shortcomings in the provision of first aid to victims with polytrauma at the prehospital stage]. Travma. 2003;4(5):587-90.
  5. Goncharov SF, Borisenko LV. Zadachi Vserosiiskoi sluzhby meditsiny katastrof po realizatsii tselevoi programmy po bezopasnosti dorozhnogo dvizheniia [Objectives of All-Russian disaster medicine service for the implementation of targeted road safety programs]. Meditsina Katastrof. 2006;(3):5-7.
  6. Shevchenko VS. Nadannia dopomogi postrazhdalim z pol³travmoiu na etap³ gostrogo per³odu travmatichno¿ khvorobi [Assistance to the victims of polytrauma during the acute period of traumatic disease]. Travma. 2003;4(4):454-56.
  7. Bondarenko AV, Peleganchuk VA, Gerasimova OA. Gospital'naia letal'nost' pri sochetannoi travme i vozmozhnosti ee snizheniia [Hospital mortality in combined injury and the possibility of its reduction]. Vestn. Travmatologii i Ortopedii. 2004;(3):49-52.
  8. Bichkov VV. Osnovn³ napriamki optim³zats³¿ nadannia medichno¿ dopomogi postrazhdalim v dorozhn'o-transportnikh prigodakh [The main directions of optimization of medical care to victims of road accidents]. Travma. 2009;10(4):430-33.
  9. Wolinsky PR. Assessment and management of pelvic fracture in the hemodynamically unstable patient. Orthop Clin North Am. 1997 Jul;28(3):321-29.
  10. Fitzgerald CA, Morse BC, Dente CJ. Pelvic ring fractures: has mortality improved following the implementation of damage control resuscitation? Am J Surg. 2014 Dec;208(6):1083-90; discussion 1089-90. doi: 10.1016/j.amjsurg.2014.09.002.
  11. Abrassart S, Stern R, Peter R. Unstable pelvic ring injury with hemodynamic instability: What seems the best procedure choice and sequence in the initial management? Orthop Traumatol Surg Res. 2013;99(2):175-82 doi: 10.1016/j.otsr.2012.12.014.
  12. Hou Z, Smith WR, Strohecker KA. Morgan Steven J. Hemodynamicallyunstable pelvic fracture management by advanced trauma life support guidelines results in high mortality. Orthopedics. 2012 Mar;35(3):e319-24. doi: 10.3928/01477447-20120222-29.
  13. Müller ME, Schneider R, Willenegger H, Allgöwer M, ed. Manual of Internal fixation. Springer-Verlag Berlin Heidelberg; 1991. 410 ð. doi: 10.1007/978-3-662-02695-3.
  14. Vlasov AP, Shevalaev GA. Sistemnyi koaguliatsionno-liticheskii distress-sindrom pri travmaticheskoi bolezni [System coagulation-lytic distress syndrome in traumatic disease]. Travmatologiia i Ortopediia Rossii. 2014;(1):80-85.
  15. Babosha VA, Pasternak VN, Lobanov VN. Nestabil'nye povrezhdeniia taza-dogospital'nyi etap pomoshchi [Unstable pelvic damage, prehospital assistance]. Ortopediia Travmatologiia i Protezirovanie. 2002;(3):147-51.
  16. Lobanov GV. Zovn³shnia f³ksats³ia poshkodzhen' taza (morfolog³chne ta eksperimental'no-mekhan³chne dosl³dzhennia [External fixation of pelvic injuries (morphological and experimental mechanical study]. V³snik Ortoped³¿ Travmatolog³¿ ta Protezuvannia. 1999;25(1):141-42.
  17. Lobanov GV, Oksimets VM, Ostroverkhov OA, Borovoi IS. Vybor taktiki lecheniia postradavshikh s mnozhestvennymi povrezhdeniiami oblasti tazobedrennogo sustava v ostrom periode travmy [The choice of tactics of treatment of patients with multiple injuries of the hip region during the acute phase of injury]. L³topis Travmatolog³¿ ta Ortoped³¿. 2003;(1,2):48-50.
  18. Kolesnikov VV, Onishchenko NS, Dushkin OF. Ispol'zovanie protivoshokovogo kostiuma «Kashtan» v lechenii tiazheloi sochetannoi travmy [Using antishock suit "chestnut" in the treatment of severe combined trauma]. Vestn Travmatologii Ortopedii im NN Priorova. 2002;(2):9-13.
  19. Schildhauer TA, Wilber JH, Patterson BM. Posterior locked lateral compression injury of the pelvis: report of three cases. J Orthop Trauma. 2000 Feb;14(2):107-11.
  20. Sokolov VA, Didenko AA, Makarov SA. Ispol'zovanie kostiuma "Kashtan" dlia neinfuzionnoi korrektsii ostroi krovopoteri i shoka pri travmakh [Using Costume "Chestnut" for a correction fluid of acute blood loss and shock with injuries]. Vestn Intensiv Terapii. 1993;(2-3):23-26.
  21. Diatlov MM. Povrezhdeniia krovenosnykh sosudov taza pri ego nestabil'nykh perelomakh i vyvikhakh u bol'nykh s sochetannoi travmoi [Damage to the blood vessels of the pelvis in its unstable fractures and dislocations in patients with combined trauma]. Vestn Travmatologii Ortopedii im NN Priorova. 1999;(2): 27-33.
  22. Failinger MS, McGanity PL. Unstable fractures of the pelvic ring. J Bone Joint Surg Am. 1992 Jun;74(5):781-91.
  23. Shirley PJ. Transportation of the critically ill and injured patient. Hosp Med. 2000;61(6):406-10. doi: 10.12968/hosp.2000.61.6.1356.
  24. Gumanenko EK, Shapovalov VM, Dulaev AK, Dydykin A V. Sovremennye podkhody k lecheniiu postradavshikh s nestabil'nymi povrezhdeniiami tazovogo kol'tsa [Current approaches to the treatment of patients with unstable pelvic ring injuries]. Voen-Med Zhurn. 2003;(4):17-24.
  25. Ankin L.N. Problemy uluchsheniia lecheniia povrezhdenii taza [Problems of improving the treatment of injuries of the pelvis]. Ortopediia Travmatologiia i Protezirovanie. 2009;(2):96-101.
  26. Tile M, Helfet DL, Kellam JF, eds. Fractures of the Pelvis and Acetabulum. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2003. 830 ð.
  27. Kukuruz IS, Burlaka VV, Bondarenko VV. Kh³rurg³chne l³kuvannia pri poЄdnan³i travm³ taza ³ tazovikh organ³v [Surgical treatment of concomitant injury of the pelvis and pelvic organs]. V³snik Ortoped³¿ Travmatolog³¿ ta Protezuvannia. 2003;(2):39-44.
  28. Rosseman R. A brief history of MAST. Pagî: Wise Inc., 2001.
  29. Pasternak VN, Babosha VA, Lobanov GV. Nestabil'nye povrezhdeniia taza - pomoshch' na etape ostrogo perioda travmy s pozitsii meditsiny ekstremal'nykh sostoianii [Unstable pelvic injuries - assistance at the stage of the acute period of injury from the standpoint of medicine of extreme conditions]. Ukr zhurn ekstremal'no¿ meditsini ³m GO MozhaЄva. 2004;(4):59-63
  30. Mardanpour K1, Rahbar M. The outcome of surgically treated traumatic unstable pelvic fractures by open reduction and internal fixation. J Inj Violence Res. 2013 Jul;5(2):77-83. doi: 10.5249/jivr.v5i2.138.
  31. Bassam D, Cephas GA, Ferguson KA, Beard LN, Young JS. A protocol for the initial management of unstable pelvic fractures. Am Surg. 1998 Sep;64(9):862-67.
  32. Pape HC, Giannoudis P, Krettek C. The timing of fracture treatment in polytrauma patients: relevance of damage control orthopedic surgery. Am J Surg. 2002 Jun;183(6):622-29.
  33. Beidik OV, Levchenko KK, Liubitskii AP, Gabatkin AI, Afanas'ev DV, Shevchenko KV, i dr. Sravnitel'naia otsenka zhestkosti fiksatsii kostnykh otlomkov spitsevymi, sterzhnevymi i spitse-sterzhnevymi sposobami naruzhnogo chreskostnogo osteosinteza [Comparative evaluation of stiffness fixation of bone fragments spoke, and spoke rod-rod outer ways chreskostnogo osteosynthesis]. Genii Ortopedii. 2003;(1):109-14.
  34. Simonian PT, Routt ML Jr, Harrington RM, Tencer AF. Anterior versus posterior provisional fixation in the unstable pelvis. A biomechanical comparison. Clin Orthop Relat Res. 1995 Jan;(310):245-51.
  35. Cherkes-Zade DI, Lapshin VB, Nozhin NP, Kamenev AF. Lechenie povrezhdenii taza s ispol'zovaniem apparatov naruzhnoi fiksatsii [Treatment of injuries of the pelvis using an external fixator]. Ortopediia Travmatologiia i Protezirovanie. 1993;(3):44-47.
  36. Ankin LN, Ankin NL. Povrezhdeniia taza i perelomy vertluzhnoi vpadiny [Damage to the pelvic and acetabular fractures]. Kiev, Ukraina: Kniga plius; 2007. 216 p.
  37. Kl³movits'kii VG, Pasternak VP, Poliachenko IuV. Pol³travma – patogenetichne obgruntuvannia l³kuval'nogo kompleksu gostrogo per³odu travmatichno¿ khvorobi [Polytrauma - pathogenetic substantiation of a medical complex of the acute period of traumatic disease]. Ukra¿ns'kii Zhurnal Ekstremal'no¿ Meditsini ³m GO MozhaЄva. 2002;3(1):11-16.
  38. Peitzman AB, Rhodes M, Schwab CW, Yealy DM, Fabian TC. The trauma manual. 2nd ed. Lippincott: Williams and Wilkins; 2003. 310 p.
  39. Džupa V, Pavelka T, Taller S. Pelvic ring injury as part of multiple trauma. Rozhl Chir. 2014;93(5):292-96.
  40. Shapovalov VM, Dulaev AK, Dydykin A.V. Eksperemental'naia razrabotka i klinicheskoe priminenie minimal'no invazivnoi vnutrennei sterzhnevoi fiksatsii tazovogo kol'tsa [Experimental and clinical development of application of minimally invasive internal fixation of pelvic ring core]. Vestn Travmatologii i Ortopedii im NN Priorova. 2001;(4):33-37.
  41. Pohlemann T. Prymary treatment of politrauma patients with pelvis traumà as leading injury. Eur J Trauma. 2002;(1):41-42.
  42. Balbachevsky D, Belloti JC, Doca DG, Jannarelli B, Junior JA, Fernandes HJ, et al. Treatment of pelvic fractures - a national survey. Injury. 2014 Nov;45(Suppl 5):S46-51. doi: 10.1016/S0020-1383(14)70021-X.
  43. Bialik EI, Fain AM. Etapnoe lechenie povrezhdenii v oblasti lonnogo sochleneniia s primeneniem original'nogo fiksatora u postradavshikh s sochetannoi travmoi taza [Staged treatment of lesions in the symphysis pubis with the original lock in victims with concomitant injury of the pelvis]. Politravma. 2013;(4):30-34.
  44. Hiesterman TG, Hill BW, Cole PA. Surgical technique: a percutaneous method of subcutaneous fixation for the anterior pelvic ring: the pelvic bridge. Clin Orthop Relat Res. 2012 Aug;470(8):2116-23. doi: 10.1007/s11999-012-2341-4.
  45. Chen HW, Liu GD, Ou S, Zhao GS, Pan J. Treatment of unstable sacral fractures with percutaneous reconstruction plate internal fixation. Acta Cir Bras. 2012 May;27(5):338-42. doi: 10.1590/S0102-86502012000500010.
  46. Li C. L. Clinical comparative analysis on unstable pelvic fractures in the treatment with percutaneous sacroiliac screws and sacroiliac joint anterior plate fixation. Eur Rev Med Pharmacol Sci. 2014;18(18):2704-8.
  47. Khanin MIu, Minasov BSh, Minasov TB, Iakupov PP, Zagitov BG. Ortopedicheskii damage-control pri povrezhdeniiakh taza u patsientov s politravmoi [Orthopedic damage-control with pelvic lesions in patients with multiple injuries]. Prakt Meditsina. 2011;(6):122-25.
  48. Smirnov AA. Operativnoe lechenie vertikal'no-nestabil'nykh povrezhdenii taza (tip S po klassifikatsii AO) [Surgical treatment of vertically unstable pelvic injuries (type C by AO classification)]. Travmatologiia i Ortopediia Rossii. 2012;(1):73-76.
  49. Donchenko SV, Dubrov VE, Sliniakov LIu, Cherniaev AV, Lebedev AF, i dr. Algoritm khirurgicheskogo lecheniia nestabil'nykh povrezhdenii tazovogo kol'tsa [The algorithm of surgical treatment of unstable pelvic ring injuries]. Vestn Travmatologii i Ortopedii im NN Priorova. 2013;(4):9-16.
Address for correspondence:
79010, Ukraine,
Lviv. Pekarskaya st., 69,
Lviv National Medical University
named after Danila Galitsky,
Department of disaster medicine
and military medicine.
Tel.: 38 (032) 260-08-28
E-mail: kozopas@ukr.net
Kozopas Viktor Stepanovich
Information about the authors:
Kozopas V.S. PhD, Assistant of department of disaster medicine and military medicine of Danylo Halytsky Lviv National Medical University.
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