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 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 Diagnostic and treatment features of concomitant injuries of pelvis and abdomen in the emergency traumatology

2016 ◽  
Vol 97 (6) ◽  
pp. 837-841
Author(s):  
V F Chikaev ◽  
R I Zakirov ◽  
D G Zaydullin ◽  
R O Il’in ◽  
G M Fayzrakhmanova
Keyword(s):  
Minimally Invasive ◽  
Ct Scan ◽  
External Fixation ◽  
Damage Control ◽  
Pelvic Injury ◽  
Minimally Invasive Osteosynthesis ◽  
Concomitant Injuries ◽  
Pelvic Injuries ◽  
Fixation Devices ◽  
Full Body

Aim. Analysis of experience of treatment of patients with concomitant injuries of pelvis and abdomen in the emergency traumatology.Methods. Analysis of features of diagnosis and treatment of 77 patients with concomitant pelvic injuries admitted to Kazan City Clinical Hospital №7 was conducted.Results. The structure of concomitant pelvic injuries is characterized by a variety of injuries, often accompanied by severe shock. Concomitant pelvic injury in 74% of patients was accompanied by shock, and in 80% of cases it was II-III grade shock. To reduce the patient’s displacement in the admission ward full body CT scan was performed, and for clarifying the scope of injuries and tactics of management CT scan of injured organs was administered. During the first hour after admission to prevent dislocation of fractures and to stop intrapelvic bleeding external fixation devices in different modifications were used depending on the injury; that allowed stabilizing hemodynamics and condition of the victims. In the second step after stabilization of the patient’s state and hemodynamics and correction of homeostasis minimally invasive surgical interventions are recommended on day 5 to 7. If abdominal injury is identified, the optimal way of external fixation of fractures is C-type fixation frame, which allows adequate access for laparotomy.Conclusion. A patient with severe concomitant trauma needs urgent full body scan with subsequent X-ray CT, staging treatment based on the principal «Damage control», early fixation of pelvic fractures with the use of external fixation devices and subsequent minimally invasive osteosynthesis, and optimal external fixation device which allows adequate access in case of surgery.

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

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.

Intraoperative Imaging in Pelvic Surgery

2018 ◽  
Vol 157 (04) ◽  
pp. 367-377 ◽  
Author(s):  
Holger Keil ◽  
Sara Aytac ◽  
Paul Alfred Grützner ◽  
Jochen Franke
Keyword(s):  
General Condition ◽  
Pelvic Ring ◽  
Intraoperative Imaging ◽  
Pelvic Surgery ◽  
Acetabular Fractures ◽  
Posterior Pelvic Ring ◽  
Data Set ◽  
Intraoperative 3D Imaging ◽  
Pelvic Injuries ◽  
Preoperative Ct

AbstractPelvic fractures may range from highly severe, life-threatening injuries to less acute clinical entities. There are several sub-entities that are summed up as pelvic injuries. Anatomically, there are fractures of the anterior or posterior pelvic ring. Apart from these, there are fractures of the acetabulum that make up about one fifth of all pelvic injuries. The indication for surgical treatment of pelvic ring injuries depends on the type of injury, involvement of anterior and/or posterior elements of the pelvic ring, demands and the general condition of the patient. In acetabular fractures, indications depend on the dislocation of the fracture and of course also the needs of the patient and his general condition. An intraarticular step-off of more than 2 mm is usually considered as an indication for open reduction and osteosynthesis. Usually in all these injuries, a preoperative CT scan is mandatory to allow precise planning of the operative approach and technique. Intraoperatively, the surgeon should be familiar with the acquisition of the 2D standard views, including 2D imaging of the pelvic ring and the acetabulum. These consist of the anteroposterior view for both pelvic ring and acetabular osteosyntheses. For further assessment of pelvic ring treatments, inlet and outlet views are achievable by angulating the C-arm cranially and caudally. To assess aspects of the anterior and posterior column of the acetabulum, iliac oblique views are used. Here, the C-arm is rotated laterally. As evaluation of 2D views can be limited due to anatomy and superposing structures, intraoperative 3D imaging has become common in the last decade. Special C-arms allow the automatic acquisition of large numbers of projections and create CT-like views of the central volume. Although this method has significantly widened the possibilities of intraoperative imaging, some issues remain. Depending on the amount of implants placed in the imaging field, assessment can be seriously impaired due to artefacts caused by the implants. Intraoperative CT imaging promises enhanced image quality for artefacts and allows a considerably larger field of view. The use of radiation-free navigation facilitates implant placement in minimally invasive procedures like screw placement in the sacroiliacal joint or the acetabulum by visualisation of instruments and implants in a pre- or intraoperative 3D data set.

scholarly journals Pelvic Fractures in Paediatric Polytrauma Patients: Classification, Concomitant Injuries and Early Mortality

2015 ◽  
Vol 9 (1) ◽  
pp. 303-312 ◽  
Author(s):  
Theodoros H Tosounidis ◽  
Hassaan Sheikh ◽  
Peter V Giannoudis
Keyword(s):  
Injury Severity ◽  
Pelvic Ring ◽  
Head Injuries ◽  
Trauma Centre ◽  
Pelvic Fractures ◽  
Concomitant Injuries ◽  
Pelvic Injuries ◽  
Transfusion Requirements ◽  
The Mean ◽  
Level I

Purpose of this Study :To review the characteristics, concomitant injuries and mortality in children with polytrauma and associated pelvic fractures treated in a Level-I Trauma Centre.Materials and Methods :Between December 2003 and November 2013, 49 children with an Injury Severity Score (ISS) of 16 or greater and a pelvic fracture met the inclusion criteria and were evaluated. The mortality, transfusion requirements and length of intensive care unit stay were correlated with the ISS, Abbreviated Injury Scale, concomitant limb and spine fractures, and type of pelvic ring injury (AO/OTA classification).Results :The mean ISS at presentation was 31.4 (range 16 to 57). 19 (38.7%) patients sustained a Type A, 27 (55.1%) a Type B and 3 (6.2%) a Type C injury. Head and face trauma was present in 33 (67.3%) cases. Blood transfusion during the resuscitation process was necessitated in six (12.2%) patients. Thirty-eight (77.5%) patients were managed non-operatively for their pelvic injuries. The mean duration of hospital stay was 23.9 days (range 1 to 146 days). In this cohort of polytrauma paediatric patients there were five (10.2%) mortalities (all suffered an associated head trauma ) within 30 days from the initial injury.Conclusion:Severe head injury and a high ISS are significantly associated with mortality in children with pelvic fractures. These patients have a high incidence of concomitant spine and chest injuries Hemorrhage due to pelvic injuries is rare. Severe head injuries predict a longer ICU stay in this population.

Epidemiological and Therapeutic Developments in Pelvic Ring Fractures Type C from 2004 to 2014 – a Retrospective Data Analysis of 2,042 Patients in the German Pelvic Register (DGU)

2021 ◽  
Author(s):  
Patricia Lang ◽  
Kerstin Schwabe ◽  
Hans-Joachim Riesner ◽  
Benedikt Friemert ◽  
Fabian Stuby ◽  
...  
Keyword(s):  
Pelvic Ring ◽  
Surgical Care ◽  
Pelvic Injury ◽  
Pelvic Ring Fractures ◽  
Retrospective Data Analysis ◽  
Pelvic Injuries ◽  
Accompanying Injuries ◽  
Stable Osteosynthesis ◽  
Special Challenge ◽  
Type C

Abstract Background Pelvic ring fractures type C present a special challenge due to their high instability, the possible accompanying injuries and the high mortality rate of up to 18.9%. The aim of this retrospective analysis was to use the data from the DGU pelvic register to identify changes in the epidemiology and therapy for type C pelvic ring fractures between 2004 and 2014. Materials and Methods 2,042 patients with type C pelvic ring injury were retrospectively included. Three time periods with roughly equal patient groups were specified and differences in epidemiology and the type of therapy were evaluated. For the surgical cases, the time of the operation, the duration of the operation, blood loss, the location of the fracture and the type of osteosynthesis were evaluated and the reduction result was recorded. Results For the period under review, there is an age shift in the incidence of a type C pelvic ring fracture towards older age. The isolated pelvic injury has increased, while the proportion of pelvic injuries in the context of polytrauma has steadily decreased. Complications and mortality decreased as a percentage. The tendency towards minimally invasive procedures could be shown in the surgical care. Navigated procedures in the area of the pelvic ring have so far not proven successful. Conclusions We were able to show that the majority of the patients are increasingly old, that there is no relevant trauma in the history and that there is an increase in the isolated pelvic fracture type C and a decrease in the number of polytraumatised or multiply injured patients. In conjunction with mortality from pelvic ring injuries, the successes of standardised, pelvic-specific emergency management, an adapted time of operation outside the vulnerable phase and stable osteosynthesis care, which enable early functional follow-up treatment, are also evident.

scholarly journals IMPROVING PROVIDE EMERGENCY MEDICAL ASSISTANCE TO VICTIMS WITH UNSTABLE FRACTURES OF THE PELVIS

2018 ◽  
Vol 18 (4) ◽  
pp. 22-27 ◽  
Author(s):  
M. B. Borisov ◽  
V. A. Manukovskiy ◽  
I. V. Kazhanov ◽  
V. V. Denisenko ◽  
A. R. Grebnev
Keyword(s):  
Pelvic Ring ◽  
Diagnostic Algorithm ◽  
Pelvic Injury ◽  
Hemodynamic Parameters ◽  
Medical Assistance ◽  
Hemodynamic Changes ◽  
Time Intervals ◽  
Pelvic Ring Fractures ◽  
Pelvic Injuries ◽  
Emergency Medical Assistance

Analysis of medical care that was administered to the injured with unstable pelvic ring fractures in the condition of theSaint Petersburgcity was done. The analysis of the effectiveness of anti-shock pelvic dressings in patients with unstable pelvic injuries and signs of unstable hemodynamic changes in the level of SBP over time. It has been found that the application of anti-shock pelvic bandage was no intermediate reduction in blood pressure, indicating a temporary halt intrapelvic bleeding and stabilize the hemodynamic parameters during time intervals sufficient to transport the victim to the nearest travmotsentr and implementation of appropriate diagnostic algorithm when pelvic injury. The necessity of using transport immobilization by fixing the unstable pelvic ring on the prehospital phase was based.

scholarly journals Use of Cannulated Screws in Pelvic Injury Surgery

2016 ◽  
pp. 25-34
Author(s):  
A. V. Bondarenko ◽  
I. V. Kruglykhin ◽  
A. N. Voitenko
Keyword(s):  
Pelvic Ring ◽  
Plate Osteosynthesis ◽  
Surgical Techniques ◽  
Pelvic Injury ◽  
Acetabular Fractures ◽  
Treatment Technique ◽  
Cannulated Screws ◽  
Pelvic Ring Injuries ◽  
Pelvic Injuries ◽  
Osteosynthesis Techniques

Osteosynthesis with cannulated screws is one of low invasive osteosynthesis techniques that does not aggravate the condition of polytraumatized patients and can be used at the early stages of treatment. The purpose of the study was to determine the peculiarities of cannulated screws application in pelvic ring and acetabular injuries. Cannulated screws were used at surgical treatment of 368 patients, aged 14–77 years, with pelvic injuries. The overwhelming majority of patients were with severe polytrauma (17 and more points by ISS score). Pelvic ring injuries (61st segment) were diagnosed in 259 (70.4%) patients, acetabular fractures (62nd segment) — in 75 (20.4%), pelvic ring injuries associated with acetabular fractures (61st and 62nd segments) — 34 (9.2%) patients. The screws were mainly used as the basic treatment technique, rarely — in combination with internal plate osteosynthesis and more rarely — in combination with external fixation device. Analysis of the results and complications was performed. Treatment results by Majeed pelvic score at terms 1 to 3 years were studied in 207 patients. Poor results were observed in 15 (7.2%) cases. Pelvic fracture osteosynthesis with cannulated screws has a number of advantages and can be referred to as one of the basic surgical techniques for pelvic fractures.

scholarly journals Hemodynamically Unstable Pelvic Fracture: A Damage Control Surgical Algorithm that Fits your Reality

2020 ◽  
Author(s):  
David Alejandro Mejia ◽  
Michael Parra ◽  
Carlos Alberto Ordoñez ◽  
Natalia Padilla ◽  
Yaset Caicedo ◽  
...  
Keyword(s):  
Pelvic Ring ◽  
Damage Control ◽  
Surgical Techniques ◽  
Limited Resource ◽  
Hemodynamic Instability ◽  
Management Approach ◽  
Trauma Patients ◽  
Pelvic Injuries ◽  
Pelvic Hemorrhage ◽  
Internal Iliac

Pelvic fractures occur in up to 25% of all severely injured trauma patients and its mortality is markedly high despite advances in resuscitation and modernization of surgical techniques due to its inherent blood loss and associated extra-pelvic injuries. Pelvic ring volume increases significantly from fractures and/or ligament disruptions which precludes its inherent ability to self-tamponade resulting in accumulation of hemorrhage in the retroperitoneal space which inevitably leads to hemodynamic instability and the lethal diamond. Pelvic hemorrhage is mainly venous (80%) from the pre-sacral/pre-peritoneal plexus and the remaining 20% is of arterial origin (branches of the internal iliac artery). This reality can be altered via a sequential management approach that is tailored to the specific reality of the treating facility which involves a collaborative effort between orthopedic, trauma and intensive care surgeons. We propose two different management algorithms that specifically address the availability of qualified staff and existing infrastructure: one for the fully equipped trauma center and another for the very common limited resource center.

Sign in / Sign up

Export Citation Format

Share Document