The role of external osteosynthesis in treatment of unstable pelvic osseous injuries

Keywords: unstable pelvic osseous injuries; change of the method; аpparatus of external fixation; metallosteosynthesis.

Abstract

Objective. To specify the role and indications for application of аpparatus of external fixation (АEF) in treatment of unstable pelvic osseous injuries (UPOI); to study up the advantages and faults of the external fixation method; to share the experience of treatment, using this procedure.

Маterials and methods. There were 229 patients, suffering pelvic injuries, examined on the base of orthopedic-traumatological centre of Kyiv’s Regional Clinical Hospital in 2005 - 2017 yrs and distributed into three Groups. In Group I 143 (62.4%) injured persons were included, in whom external osteosynthesis played the function of temporary measures of fixation, in Group II - 27 (11.8%) patients, in whom while hospitalization a fracture was fixed, using AEF, аnd after stabilization of the state the posterior pelvis osteosynthesis and reposition was conducted, in Group III - 59 (25.8%) patients, who, using several indications, were definitely treated, applying the external fixation method only.

Results. Excellent effect of treatment in Group I was registered in 23 (19.0%), a good one - in 58 (47.9%), satisfactory - in 32 (26.4%), poor - in 8 (6.6%) of 121 patients; in Group II - accordingly, - in 5 (20.8%), 11 (45.8%), 7 (29.2%) and 1 (4.2%) of 24 patients; in Group III - accordingly, in 4 (8.3%), 12 (25%), 23 (47.9%) and 9 (18.6%) of 48 patients.

Conclusion. Best results of treatment of patients with unstable pelvic osseous injuries were obtained while applying the tactics of change from external fixation into internal one. On the first stage the pelvic ring fixation, using AEF, was performed, аnd after stabilization of a patient general status - internal osteosynthesis. Application of the internal osteosynthesis method permits to control and stabilize the reposition achieved, to conduct the sacro-ileal joint revision.

Author Biographies

N. L. Аnkin, Kyiv Regional Clinical Hospital

Mykola Ankin - MD, DSci, professor,
Head of the Department of Orthopedics and Traumatology №2
Shupyk National Medical Academy of Postgraduate Education,
Chief Medical Officer
Kyiv Regional Clinical Hospital
1, Baggovutivska str., 04107, Kyiv, Ukraine,
phone 483-13-76,
e-mail: m.ankin@ukr.net
ORCID: http://orcid.org/0000-0001-9795-0931

L. N. Аnkin, Kyiv Regional Clinical Hospital

Lev Ankin - MD, DSci, professor,
military surgery Ukrainian Military Medical Academy.
Kyiv Regional Clinical Hospital
1, Baggovutivska str., 04107, Kyiv, Ukraine,
phone 067-250-86-33
ORCID: http://orcid.org/ 0000-0001-8242-5499

T. M. Petryk, Shupyk National Medical Academy of Postgraduate Education, Kyiv

Taras Petryk - MD, PhD,
Head of the Orthopedics and Traumatology
Kyiv Regional Clinical Hospital
assistant of the Department of Orthopedics and Traumatology №2
Shupyk National Medical Academy of Postgraduate Education.
1, Baggovutivska str., 04107, Kyiv, Ukraine,
phone 067-749-15-72,
e-mail: petryktaras.m.d@gmail.com
ORCID: http://orcid.org/0000-0002-5319-3921

V. А. Ladyka, Shupyk National Medical Academy of Postgraduate Education, Kyiv

Viktoriia Ladyka - MD, assistant
Department of Orthopedics and Traumatology №2
Shupyk National Medical Academy of Postgraduate Education,
doctor orthopedist traumatologist
Orthopedics and Traumatologyy Center
Kyiv Regional Clinical Hospital”.
1, Baggovutivska str., 04107, Kyiv, Ukraine,
phone 063-495-74-08,
e-mail: Ladika084@gmail.com
ORCID: http://orcid.org/0000-0002-3796-428X

References

Lazarev AF, Gudushauri JaG, Kostiv EP, Solod JeI, Kakabadze MG, Roskidajlo AS. Klinicheskie aspekty oslozhnenij povrezhdenij taza. Tihookeanskij medicinskij zhurnal. 2017(Jan);(1):17-23. doi: 10.17238/PmJ1609-1175.2017.1.17-23. [In Russian].

Borisov MB, Manukovskij VA, Kazhanov IV, Denisenko VV, Grebnev A.R. Sovershenstvovanie okazanija skoroj medicinskoj pomoshhi postradavshim s nestabil'nymi perelomami kostej taza. Skoraja medicinskaja pomoshh'. 2018(Oct);18(4): 22-7. doi: 10.24884/2072-6716-2017-18-4-22-27. [In Russian].

Ibragimov FI. Osobennosti taktiki lechenija pri sochetannyh travmah zhivota i taza. Hirurgija. Zhurnal im. N. I. Pirogova. 2018(Jan);(10):34-8. doi:10.17116/hirurgia201810134. [in Russian].

Kolesnik AI, Dokalin AJu, Solodilov IM, Frolov EB, Angalev EM, Pirogov MA, Rahimzjanov RSh. Retrospektivnyj analiz rezul'tatov konservativnogo i operativnogo lechenija bol'nyh s povrezhdenijami taza. Kurskij nauchno-prakticheskij vestnik «Chelovek i ego zdorov'e». 2017;(2):17-23. doi: 10.21626/vestnik/2017-2/03. [In Russian].

Ivchenko VK, Lobanov GV, Rodichkin VA, Lubenec AA. Nash opyt primenenija sterzhnevyh apparatov vneshnej fiksacii dlja lechenija postradavshih s nestabil'nymi povrezhdenijami tazovogo kol'ca. Travma. 2010;11(3):327-30. [In Russian]

Henderson RC. The long-term results of nonoperatively treated major pelvic disruptions. Journal of orthopaedic trauma. 1989;3(1):41-7. PMID:2523480.

Tile M, Helfet D, Kellam J. Fractures of the pelvis and acetabulum. Lippincott Williams & Wilkins; 2003. 850 p.

Tile M, Helfet D, Vrahas M, Kellam J. Fractures of the Pelvis and Acetabulum; 2015. 1043 p.

Majeed SA. Grading the outcome of pelvic fracture. J. Bone Joint Surg Br. 1989 (Mar); 71(2):304-6. doi:10.1302/0301-620X.71B2.2925751.

Hak DJ, Smith WR, Suzuki T. Management of hemorrhage in life-threatening pelvic fracture. J Am Acad Orthop Surg. 2009;17(7):447-57. PMID: 19571300.

Cothren CC, Osborn PM, Moore EE, Morgan SJ, Johnson JL, Smith WR. Preperitonal pelvic packing for hemodynamically unstable pelvic fractures: a paradigm shift. J Trauma. 2007;62(4):834-42. doi: 10.1097/TA.0b013e31803c7632.

Kim WY, Hearn TC, Seleem O, Mahalingam E, Stephen D, Tile M. Effect of pin location on stability of pelvic external fixation. Clin Orthop Relat Res. 1999(Apr);(361):237-44. doi: 10.1097/00003086-199904000-00030.

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.org/10.1016/j.otsr.2012.12.014.

Halawi MJ. Pelvic ring injuries: Emergency assessment and management. J Clin Orthop Trauma. 2015;6(4):252-8. doi.org/10.1016/j.jcot.2015.08.002.

Wong JML, Bucknill A. Fractures of the pelvic ring. Injury. 2017;48(4):795-802. doi.org/10.1016/j.injury.2013.11.021.

Published
2019-05-05
How to Cite
АnkinN. L., АnkinL. N., Petryk, T. M., & LadykaV. А. (2019). The role of external osteosynthesis in treatment of unstable pelvic osseous injuries. Klinicheskaia Khirurgiia, 86(5), 48-53. https://doi.org/10.26779/2522-1396.2019.05.48
Section
General Problems of Surgery