Surgical correction of the pelvic ring in patients with severe combined trauma

Aim. To optimize the surgical treatment of unstable fractures of the pelvic bones in the acute period of combined trauma.

Materials and methods. This study analyzed the treatment outcomes of 57 patients with combined pelvic trauma at City Medical Center No. 3 in Dushanbe and the State Institution “Istiklol Medical Complex” from 2015 to 2019. According to the M.E. Muller-AO/ASIF classification, the types of pelvic injuries were as follows: Type B1 in 18 cases (31.6%), Type B3 in 11 cases (19.3%), Type C1 in 16 cases (28%), and Type C2 in 12 cases (21.1%). Based on the AO Tile classification, Type A fractures (stable with minimal displacement and without disruption of the pelvic ring) were observed in 26 patients (45.6%). Type B fractures (rotationally unstable but vertically stable) occurred in 18 patients (31.6%), and Type C fractures (with rotational and vertical instability and complete disruption of the pelvic ring) were noted in 13 patients (22.8%).

Results. The treatment results indicate that the best functional outcomes were achieved in patients from Group III (13 cases) and those with acetabular fractures (7 cases), where submerged osteosynthesis was performed in 13 (22.8%) and 5 (8.8%) cases, respectively, the latter in combination with external fixation devices. In the second group, the best functional and anatomical results were achieved in 18 patients (31.6%) using external fixation devices.

Conclusion. Early restoration of pelvic integrity through active surgical correction prevents the development of lifethreatening complications during the acute phase, facilitates patient mobilization, and reduces the rehabilitation period. A phased surgical correction of the pelvis, adhering to the principle of “damage under control,” ensures a favorable prognosis and satisfactory outcome.

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