Surgical Treatment for Unstable Pelvic Ring Injuries

Abstract

Treatment results for 67 patients (43 men, 24 women), aged 15–70 years, with unstable pelvic ring injuries are presented. In 15 cases conservative treatment (control group) and in 52 cases various surgical interventions (main group) were performed. In the main group of patients a strategy of two5step surgical treatment of the victims with multiple and concomitant injuries Damage control concept was applied. It included urgent stabilization of pelvic ring with external fixation devices and C-frame, bleeding arrest, final fixation within first 5–7 days after stabilization of patient’s condition. Restoration of the anterior semi5ring was performed using either external fixation device or a reconstructive plate. Stabilization of sacroiliac junction was per5 formed with cannulated screws. All patients were allowed to walk on crutches within 1–5 days after operation. In control and main groups the duration of hospitalization made up 43.7±2.5 and 25.7±3.1 days (p<0.05), respectively. Long term (1 year) treatment results were assessed by Majeed scale and SF-36 questionnaire were used. By Majeed scale excellent results in main group were achieved in 35 (67.3%), good – 11 (21%) and satisfactory – in 6 (11.5%) patients. In control group no excellent results were obtained, good results were obtained in 6 (40%) and satisfactory in 9 (60%) patients. By SF-36 questionnaire treatment results in main group statistically significant (p<0.001) surpassed the results achieved in control group. Thus, stable fixation of both anterior and posterior semirings enables to initiate early mobilization without risk of reposition loss that is very important for the patients with multiple and concomitant injuries.

Full Text

Алгоритм хирургического лечения нестабильных повреждений тазового кольца
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References

  1. Казанцев А.Б., Путягин С.М., Ли Э.А., Гнитиев М.Е., Тер-Григорян А.А., Чилисов А.М. Оперативное лечение нестабильных повреждений тазового кольца. В кн. Сборник материалов Международной Пироговской научно-практической конференции «Остеосинтез и эндопротезирование». М.; 2008: 79.
  2. Лазарев А.Ф., Костенко Ю.С. Большие проблемы малого таза. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2007; 4: 83–7.
  3. Минасов Б.Ш. Внеочаговый остеосинтез полифокаль ных нестабильных повреждений костей таза при множественной травме. В кн.: Материалы конгресса травматологов-ортопедов России. Ярославль; 1999: 254.
  4. Черкес-Заде Д.И. Лечение повреждений таза и их последствий. М.: Медицина; 2006.
  5. Fell M., Meissner A., Rahmanzadeh R. Long-term outcome after conservative treatment of pelvic ring injuries and conclusion for current management. Zenralbi. Chir. 1995; 120 (11): 81–5.
  6. Borelli J.Jr., Koval K.J. Helfer D.L. Operative stabilization of fracture dislocations of sacroiliac joint. Clin. Orthop. Relat. Res.1996; (329): 141–6.
  7. Pape H.-C., Giannoudis P., Krettek C. The timing of fracture treatment in polytrauma patients: relevance of damage control orthopaedic surgery. Am. J. Surg. 2002; 183: 622–9.
  8. Schildhauer T.A., Ledoux W.R., Chapman J.R., Henley M.B., Tencer A.F., Routt M.L. Jr. Triangular osteosynthesis and iliosacral screw fixation for unstable sacral fractures: a cadaveric and biomechanical evaluation under cyclic loads. J. Orthop. Trauma. 2003; 17 (1): 22–31.
  9. Tile M. Acute pelvic fractures: Principles of management. Surgery. 2002; 132 (4): 152–61.
  10. Pohlemann T., Bosch U., Gänsslen A., Tscherne H. The Hannover experience in management of pelvic fractures. Clin. Orthop. 1994; (305): 69–80.
  11. Tile M., Helfet D.L., Kellam J.F., eds. Fractures of the pelvis and acetabulum. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2003.
  12. Vaccaro A.R., Kim D.H., Brodke D.S., Harris M., Chapman J.R., Schildhauer T., Routt M.L., Sasso R.C. Diagnosis and management of sacral spine fractures. Instr. Course Lect. 2004; 53: 375–85.
  13. Majeed S.A. Grading the outcome of pelvic fractures. J. Bone Joint Surg. 1989; 71 (2): 304–6.
  14. Соколов В.А., Щеткин В.А. Оперативное лечение разрывов лобкового симфиза и крестцово-подвздошного сочленения при множественной и сочетанной травме. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2002; 2: 3–8.
  15. Keating J.F.W., Blachut J., Broekhuyse P., Meek H., O’Brien R.N. Early fixation of the vertically unstable pelvis: the role of iliosacral screw fixation of the posterior lesion. J. Orthop. Trauma. 1999; 13 (2):107–13.
  16. Reminger A., Engelhardt P. Percutaneous iliosacral screw fixation of vertical unstable pelvic ring fractures. Swiss Surg. 1996; 2 (6): 259–63.
  17. Лазарев А.Ф., Солод Э.И., Костенко Ю.С. Металлодез переднего полукольца таза. В кн.: Материалы III международного конгресса «Современные технологии в травматологии и ортопедии». М.; 2006: 34–5.
  18. Soultanis K., Karaliotas G.I., Mastrokalos D., Sakellariou V.I., Starantzis K.A., Soucacos P.N. Lumbopelvic fracture-dislocation combined with unstable pelvic ring injury: one stage stabilization with spinal instrumen- tation. Injury. 2011; 42 (10): 1179–83.
  19. Черкес-Заде Д.И., Нечволодова О.Л., Лазарев А.Ф., Морозов А.К., Уразгильдеев Р.З. Диагностика скрытых повреждений тазового кольца. Вестник травматологии и ортопедии им. Н.Н. Приорова. 1998; 2: 15–8.
  20. Denis F., Davis S., Comfort T. Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin. Orthop. Relat. Res. 1988; 227: 67–81.
  21. Griffin D.R., Starr A.J., Reinert C.M., Jones A.L., Whitlock S. Vertically unstable pelvic fractures fixed with percutaneous iliosacral screws: does posterior injury pattern predict fixation failure? J. Orthop. Trauma. 2003; 17: 399–405.
  22. Letournel E., Judet R. Fractures of the acetabulum. 2nd ed. New York: Springer; 1993.
  23. Matta J.M., P. Tornetta 3rd. Internal fixation of unstable pelvic ring injuries. Clin. Orthop. Relat. Res. 1996; (329): 129–40.
  24. Ware J.E. Measuring patients’ views: the optimum outcome measure. SF 36: a valid, reliable assessment of health from the patient’s point of view. Br. Med. J. 1993; 306: 1429–30.

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