Novosti
Khirurgii
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indexed in Scopus



Year 2015 Vol. 23 No 4

REVIEWS

DOI: http://dx.doi.org/10.18484/2305-0047.2015.4.452   |  

Y.G. SHAPKIN, P.A. SELIVERSTOV

STRATEGY FOR SURGICAL TREATMENT OF POLYTRAUMA WITH UNSTABLE PELVIC INJURIES

SBEE HPE "Saratov State Medical University Named after V.I. Razumovsky"
The Russian Federation

A review of the scientific literature identified the main factors influencing the choice of therapeutical strategy in polytrauma with unstable pelvic injuries; the options for surgical treatment as well as the advantages and disadvantages of current methods of continuous intrapelvic hemorrhage stopping, external and internal fixation of the pelvis injuries in polytrauma are also presented.
The high incidence of development of shock, massive interstitial hemorrhage, endogenous intoxication syndrome, hypostatic complications, the importance of an anatomically accurate reconstruction of the pelvic ring for functional outcome require special treatment tactics in polytrauma with pelvic injuries. Fixation of unstable pelvic ring injuries with a fixator and continuous intrapelvic hemorrhage stopping using angiographic arterial embolization, extraperitoneal tamponade in polytrauma proven to be some anti-shock urgent measures. Early surgical fixation of unstable pelvic injuries in polytrauma can prevent the development of endogenous intoxication syndrome, disseminated intravascular coagulation, multiple organ failure, to reduce the frequency of hypostatic complications, mortality rate and to improve functional outcomes. Terms and extent of surgical interventions for pelvic injuries in polytrauma are based on the severity of the patients condition, the period of traumatic disease. In patients in critical condition the staged surgical treatment of unstable pelvic injuries with temporary external fixation devices and the subsequent final stabilization of the internal fixator correspond to the concept of "Damage Control" and this allows obtaining maximum benefit from both techniques. Treatment of acetabulum fractures and damages in the structural integrity of the pelvic ring should comply with the treatment principles of intra-articular fractures and requires accurate anatomical reposition and pelvic stability.

Keywords: treatment strategy, polytrauma, unstable pelvic injuries, treatment of intra-articular fractures, hypostatic complications, external fixation, internal fixation
p. 452-459 of the original issue
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Address for correspondence:
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Seliverstov Pavel Andreevich
Information about the authors:
Shapkin Y.G. MD, professor, a head of the general surgery chair, SBEE HPE "Saratov State Medical University named after V.I. Razumovsky".
Seliverstov P.A. PhD, an assistant of the general surgery chair, SBEE HPE "Saratov State Medical University named after V.I. Razumovsky".
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