Treatment of pelvic fractures of patients with polytrauma

We treated 310 patients with pelvic fractures. According to the classification of M. Tile, the fractures were allocated in the following manner: A, 43%; B, 29%; C, 28%. Forty-four percent of these patients were admitted with different rates of severity of shock state. Osteosynthesis was carried out in 44% cases: 23%, external fixation only; 9%, internal constructions only; and 12%, combined synthesis. The treatment of pelvic fractures must correspond to the requirements of anti-shock measures and to the treatment of intra-articular lesions. The most informative method of the radial diagnosis is CT examination with three-dimensional pelvic reconstruction. We oriented toward the severity of pelvic lesion (A, B, C) for the determination of the terms, the volume and the order of surgical interventions. We carried out the total volume of surgical interventions in the consideration of the severity of pelvic lesions in the shock of I and II rates. We used internal or combined osteosynthesis in the partial or total loss of pelvic stability (B and C types). Internal osteosynthesis of the pelvis is biomechanically substantiated, because it regains the circular form and, consequently, also the pelvic stability, it decreases hemorrhage from the fracture regions, and it removes the pain more rapidly. Hemorrhage compensation was realized by intraoperative autohemotransfusion. In case of another dominant lesion, we operated by means of two brigades. In the shock of III and IV rates we carried out the pelvic stabilization only by the external fixation apparatus for the improvement of the common state of the patient. Closed reposition and osteosynthesis by external fixation apparatus with an anterior frame does not ensure complete success in the fractures of type C, but it is the most rapid method to obtain and to maintain reposition in the future.

Functional results were appreciated at the moment of discharge and after 12 months according to the Majeed S.A. scale (1989) and according to the data of computerized optic topography to appreciate the postural balance. Good and excellent results (70–100 points for the workers and 55–80 points for nonworkers) were in 48% patients at the moment of discharge and in 78% patients after 12 months. The lethality value was 5.5%. The invalidism value was 7%. The mean time of hospital stay was 34 days and the mean time of resuscitation department stay was 1.5 days.

The treatment of the patients with severe injuries of the pelvis in polytrauma must be realized in special clinics, with necessary equipment and specially prepared nursing. Treatment tactics depend on the severity of the common state and on the severity of pelvic injuries.