Surgical Treatment for Unstable Pelvic Ring Injuries

2013 ◽  
Vol 20 (4) ◽  
pp. 9-16
Author(s):  
S. V Donchenko ◽  
V. E Dubrov ◽  
L. Yu Slinyakov ◽  
A. V Chernyaev ◽  
A. F Lebedev ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
External Fixation ◽  
Pelvic Ring ◽  
Damage Control ◽  
Main Group ◽  
Control Group ◽  
Concomitant Injuries ◽  
Surgical Interventions ◽  
Pelvic Ring Injuries ◽  
Unstable Pelvic Ring Injuries

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

scholarly journals Minimum Invasive Stabilizing and Decompressive-Stabilizing Methods of Surgical Treatment for Degenerative-Dystrophic Lesions of Spine

2011 ◽  
Vol 18 (4) ◽  
pp. 3-10
Author(s):  
A V Krut'ko ◽  
Shamil' Al'firovich Akhmet'yanov ◽  
D M Kozlov ◽  
A V Peleganchuk ◽  
A V Bulatov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Lumbar Spine ◽  
Surgical Techniques ◽  
Pain Syndrome ◽  
Early Postoperative Period ◽  
Main Group ◽  
Control Group ◽  
Surgical Interventions ◽  
Comparative Group ◽  
Operative Wound

Results of randomized prospective study with participation of 94 patients aged from 20 to 70 years with monosegmental lumbar spine lesions are presented. Minimum invasive surgical interventions were performed in 55 patients from the main group. Control group consisted of 39 patients in whom decompressive-stabilizing operations via conventional posteromedian approach with skeletization of posterior segments of vertebral column were performed. Average size of operative wound in open interventions more than 10 times exceeded that size in minimum invasive interventions and made up 484 ± 56 and 36 ± 12 sq.cm, respectively. Mean blood loss was 326.6 ± 278.0 ml in the main group and 855.1 ± 512.0 ml in the comparative one. In the main group no one patient required substitution hemotransfusion, while in 13 patients from the comparative group donor erythrocytic mass and/or fresh-frozen plasma were used to eliminate the deficit of blood components. Intensity of pain syndrome in the zone of surgical intervention by visual analog scale in the main group was lower than in comparative group. In the main and comparative groups the duration of hospitalization made up 6.1 ± 2.7 and 9.7 ± 3.7 bed days, respectively. In no one patient from the main group complications in the zone of operative wound were noted. Three patients from the comparative group required secondary debridement and in 1 patient early deep operative wound suppuration was observed. Application of low invasive surgical techniques for the treatment of patients with degenerative lumbar spine lesions enabled to perform radical surgical treatment with minimal iatrogenic injury. The method possessed indubitable advantages over the conventional open operations especially intraoperatively and in early postoperative period.

scholarly journals Standard open operative interventions in surgical treatment of patients, suffering an acute complicated pancreatitis

2018 ◽  
Vol 85 (7) ◽  
pp. 27-29
Author(s):  
V. P. Аndriushchenko ◽  
D. V. Аndriushchenko ◽  
Yu. S. Lysiuk
Keyword(s):  
Surgical Treatment ◽  
Comparison Group ◽  
Surgical Intervention ◽  
Main Group ◽  
Control Group ◽  
Treatment Results ◽  
Surgical Interventions ◽  
Second Stage ◽  
Standard Operations

Objective. To determine the character and optimal volume of standard open surgical interventions in an acute complicated pancreatitis (ACP) with elaboration of the main technical elements of the operations. Маterials and methods. There were operated 96 patients, suffering ACP. The main group consisted of 47 patients, in whom open interventions were performed primarily in 19, and as the second-stage procedure after application of miniinvasive interventional technologies (МIТ) – in 28. The comparison group consisted of 49 patients, in whom standard operations were done only. Results. Application of MIТ have promoted the indications narrowing for performance of primary open operations more than twice. In the main group the arcuate-like subcostal access was applied predominantly - in 26 (55%) observations (χ²=14.287; р=002), while in a control one – a median upper laparotomy – in 37 (76%) observations (χ²=38.43, р < 0.001). The method of closed draining in accordance to procedure of Beger was used predominantly in the main group of patients – in 43% of observations, comparing with a control group - 9% of observations (χ²=12.965; р=0.003). In 23% patients of the main group and in 26% patients of a control one (χ²=0.0013; р=0.05), when the extended purulent-necrotic inflammation process have presented, a staged sanation was applied, using programmed relaparotomies. Some technical elements of the surgical intervention were improved. Conclusion. Application of standard open operations in accordance to elaborated principle is accompanied by improvement of the treatment results in patients, suffering ACP.

scholarly journals Evaluation of the effectiveness of the use of low-traumatic surgical access in the reverse shoulder arthroplasty

2021 ◽  
Vol 28 (2) ◽  
pp. 21-28
Author(s):  
Gurgen A. Kesyan ◽  
Grigoriy S. Karapetyan ◽  
Artem A. Shuyskiy ◽  
Rashid Z. Urazgil'deev ◽  
Igor' G. Arsen'ev ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Surgical Technique ◽  
Shoulder Arthroplasty ◽  
Shoulder Joint ◽  
Subcutaneous Tissue ◽  
Reverse Shoulder Arthroplasty ◽  
Main Group ◽  
Control Group ◽  
Surgical Interventions ◽  
Surgical Access

BACKGROUND: The number of reversible shoulder joint endoprostheses installed in the world at the present stage is several times greater than the number of hemiarthroplasty performed. Nevertheless shoulder arthroplasty is considered a traumatic operation and can be accompanied by a number of complications, both from the side of implants and due to the traumatic nature of the surgical technique. During surgical interventions on the shoulder joint with a wide dissection of the skin and subcutaneous tissue, iatrogenic damage to structures such as the axillary nerve, posterior and anterior arteries and veins surrounding the humerus can often be detected, which triggers a whole cascade of pathophysiological and regulatory processes in which Interventions immediately release inflammatory mediators. Therefore, orthopedic traumatologists strive to reduce the risk of intra- and postoperative complications, and it is necessary to improve the surgical technique of surgical interventions towards their less traumatic performance. AIM: Development and evaluation of the effectiveness of the use of low-traumatic surgical access when performing reverse shoulder arthroplasty. MATERIALS AND METHODS: In the period 20172020, 169 patients with various diseases, injuries of the shoulder joint and their consequences were operated on in the Department of Adult Orthopedics of the N.N. Priorov National Research Medical Center of the Russian Federation, who underwent reverse shoulder arthroplasty according to generally accepted indications. In the main group (84 patients), surgical treatment was performed using a low-traumatic surgical approach, while the control group (85 patients) underwent standard procedures. Functional, clinical and radiological results of surgical treatment of patients of the main and control groups were evaluated and compared after 3, 6 and 12 months. RESULTS: In the main group, excellent results (25 points on DASH) were observed in 73 patients, good results (2650 points) in 10 patients. In 1 patient, the results were assessed as satisfactory (5175 points). In the control group of observation, the clinical result was worse (68 excellent, 16 good and 1 satisfactory result). CONCLUSION: On the basis of the performed study, taking into account the better results in the main group of patients, the technique of low-traumatic surgical access for reverse shoulder arthroplasty can be recommended for wide use in clinical practice.

scholarly journals Temporary External Fixation to Table as a Traction Reduction Aide in the Treatment of Unstable Pelvic Ring Injuries: A Technical Note

Hip & Pelvis ◽  
2020 ◽  
Vol 32 (4) ◽  
pp. 214
Author(s):  
Filippo Romanelli ◽  
Eric Boe ◽  
Li Sun ◽  
David M. Keller ◽  
Richard S. Yoon ◽  
...  
Keyword(s):  
External Fixation ◽  
Pelvic Ring ◽  
Technical Note ◽  
Pelvic Ring Injuries ◽  
Unstable Pelvic Ring Injuries

scholarly journals Emergent Stabilization of Pelvic Bones Fractures in Polytrauma

2014 ◽  
pp. 19-25 ◽  
Author(s):  
E. A. Litvina
Keyword(s):  
General Condition ◽  
Pelvic Ring ◽  
Damage Control ◽  
Pelvic Injury ◽  
Treatment Concept ◽  
Concomitant Injuries ◽  
Surgical Interventions ◽  
Acute Period ◽  
Pelvic Injuries ◽  
Modern Treatment

Principle aspects of the management of patients with concomitant pelvic injury and injuries of other localization from the standpoint of modern treatment concept Damage control are discussed. Special attention are paid to the techniques for pelvic ring fixation, arrest of intrapelvic hemorrhage, sequence of surgical interventions depending on the pattern of concomitant injuries. The necessity of emergent pelvic injuries fixation with external devices as well as the fractures of other localization in the acute period until stabilization of patient’s general condition is substantiated

scholarly journals Emergent Stabilization of Pelvic Bones Fractures in Polytrauma

2014 ◽  
Vol 21 (1) ◽  
pp. 19-25
Author(s):  
E. A Litvina
Keyword(s):  
General Condition ◽  
Pelvic Ring ◽  
Damage Control ◽  
Pelvic Injury ◽  
Treatment Concept ◽  
Concomitant Injuries ◽  
Surgical Interventions ◽  
Acute Period ◽  
Pelvic Injuries ◽  
Modern Treatment

Principle aspects of the management of patients with concomitant pelvic injury and injuries of other localization from the standpoint of modern treatment concept Damage control are discussed. Special attention are paid to the techniques for pelvic ring fixation, arrest of intrapelvic hemorrhage, sequence of surgical interventions depending on the pattern of concomitant injuries. The necessity of emergent pelvic injuries fixation with external devices as well as the fractures of other localization in the acute period until stabilization of patient’s general condition is substantiated

scholarly journals Surgical treatment of unstable pelvic ring fractures

2019 ◽  
Vol 76 (1) ◽  
pp. 36-41
Author(s):  
Miroslav Kezunovic ◽  
Nikola Bulatovic
Keyword(s):  
Surgical Treatment ◽  
Femoral Head ◽  
Internal Fixation ◽  
External Fixation ◽  
Pelvic Ring ◽  
Early Mobilization ◽  
Skeletal Traction ◽  
Pelvic Ring Injuries ◽  
Pelvic Ring Fractures ◽  
Stable Osteosynthesis

Background/Aim. Pelvic ring fractures are complex injuries and are often associated with internal organs injuries. These injuries require rapid and accurate diagnosis and in some cases one or more surgical interventions. The aim of this retrospective study is to describe the indications and outcomes of surgical treatment of pelvic ring injuries with the emphasis on anatomical reconstruction and stable osteosynthesis as a prerequisite for early mobilization and more favorable functional outcomes. Methods. In the period from 2006 to 2012, fifty-five patients with pelvic ring injuries with or without acetabular fractures were analyzed. The average age of all patients was 36 years. Forty-one patients were treated with operational open reduction and internal fixation (ORIF) while nine of them were treated nonoperatively (bed rest, skeletal traction and external fixation). Results. All operated patients were treated within 3- 24 days with ORIF, stable osteosynthesis and early mobilization which resulted in avascular necrosis (AVN) of the femoral head in two cases. AVN of the femoral head was noted in five cases in combined and isolated pelvic ring injuries and acetabulum which were treated with skeletal traction. Neurological deficit was recorded in three patients treated with conservative methods while two patients underwent ORIF. Deep vein thrombosis (DVT) was noted in two patients and pulmonary thromboembolism appeared in one patient 23 days after surgical intervention. Two infections occurred around Steinman pins in the patients who had the definitive treatment performed with external fixator. In one patient treated with ORIF a superficial infection occurred and was treated with antibiotics. The functional results were evaluated based on Merle d'Aubign? score. The results of the radiography treatment were analyzed according to Slatis. Conclusion. Strict application of rational criteria and surgical technique with stable internal fixation with early mobilization provide significantly better outcomes of these injuries in relation to non surgical treatment or treatment with definitive external fixation.

Problems of surgical treatment of the anterior pelvic ring chronic injuries

2021 ◽  
Vol 19 (3) ◽  
pp. 47-54
Author(s):  
A. F. LAZAREV ◽  
◽  
E. I. SOLOD ◽  
YA. G. GUDUSHAURI ◽  
E. I. KALININ ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Pelvic Ring ◽  
Metal Structure ◽  
Complex Problem ◽  
Long Term Results ◽  
Fixation Method ◽  
Surgical Interventions ◽  
Anterior Section ◽  
Pelvic Injuries ◽  
Study Results

A surgical treatment of the joints of the pelvic ring, especially the pubic joint is a separate and complex problem. When using standard plates, which are applied in the treatment of patients with fresh injuries to stabilize old injuries of the pelvic ring, problems arise with fatigue fracture of plates, destabilization of the metal structure and the need for repeated surgical interventions. Therefore, in the case of old injuries, during surgical treatment, it is necessary to use other tactical approaches to fixing pelvic injuries and to search for adapted structures for such cases. The purpose — to study the features of fixation of old injuries of the pelvic ring and to determine the results of different methods of the anterior pelvis fixation in old cases. Materials and methods. A retrospective analysis of the performed surgical treatment was carried out. In 2000-2015, in the first department of National Medical Research Center of Traumatology and Orthopedics named after N.N. Priorov, 117 patients underwent surgical treatment of old injuries of the anterior pelvic ring under our supervision using standard reconstructive plates applied in the surgical treatment of new injuries of the pelvic ring. Results. Of the 65 patients who underwent fixation of an old injury of the anterior semiring with AO reconstructive plates and AO pelvic plates, installed in a standard manner as in new injuries, 12 patients (10,2%) experienced migration or fracture of structures within 2 to 6 months from the operation. In 52 patients, fixation of the anterior section with two AO plates was applied, one of which was located in a standard way along the upper edge of the pubic bones, the second was implanted additionally along the anterior surface of the pelvic ring perpendicular to the first one. In this group, migration and destabilization of the structures was observed in 7 patients (13,4%) within a period from 2 weeks to 2 months from the date of the operation. Conclusion. The analysis of the study results suggests that surgical treatment of old injuries of the anterior pelvic ring requires a special approach to the choice of the surgical fixation method, which differs from the treatment of new injuries. Over time, in the absence of treatment for injuries and ruptures of the pelvic ring, cicatricial-fibrous adhesions of the pelvic ring occur, which does not always ensure the stability of the pelvic ring, but leads to rigid post-traumatic deformity of the pelvis. Taking into account the cases of destabilization in groups 1 — 10,2% and 2 — 13,4%, as well as the assessment of the long-term results according to the Majeed scale, the use of standard methods for fixing the anterior pelvic semiring can be considered ineffective in old pelvic injuries.

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