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The surgical treatment of pelvis fractures with multiple and associated injuries


Author: Kusturov Vladimir
Degree:doctor habilitat of medicine
Speciality: 14.00.22 - Orthopedics and Traumatology
Year:2009
Scientific consultants: Filip Gornea
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Gheorghe Ghidirim
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 8 April, 2009
Approved by NCAA on the 18 June, 2009

Abstract

Adobe PDF document0.89 Mb / in romanian

Keywords

pelvis – pelvic ring – biomechanics – fractures type A, B, C – multiple and associated injuries – examination – treatment – early osteosynthesis – external device – correction of the vertically unstable fractures – mobility and support

Summary

Aim of this study is to elaborate and prove the efficiency of the treatment system of the pelvis fractures in patients with multiple and associated injuries based on the use of miniinvasive methods and devices that ensure patient early mobility and programmed favorable outcomes.

The study represents a prospective analysis of the examination and treatment results of 233 patients with pelvis fractures and multiple and associated trauma. It was established that the main cause of trauma was traffic road accident (64,37%), fall from height (25,32%) and high-energy stroke with the following compression of the patient (10,31%) when severe injuries of the chest and abdomen organs were presented. The injuries severity was calculated using AIS and ISS scales. It was presented the specifics of diagnostics and treatment of patients with polytrauma. The patients were divided in 3 groups according to M.Tile classification: with pelvic fractures type A – 96, type B – 59, type C – 78. The anatomic optimal zones for safety introduction of fixative elements were determined, we performed the comparative analysis of harshness of the contact “fixative element – bone”. The particularities of diagnostic and management of pelvioabdominal trauma were presented. The indications for stabilizing, early and delayed osteosynthesis were made more precise. Stabilizing osteosynthesis was carried out in 43 patients at admission to the hospital and during the first 48 hours after trauma. Early osteosynthesis was done in 157 cases during 3-14 days after trauma. Delayed osteosynthesis was performed in 26 cases after 3 weeks. It was established that patient hemodynamics was stabilized after pelvis osteosynthesis by external fixation device: the volume of transfusion decreased on 1,2±0,2 liter per day (p<0,05) (average for one patient), blood preparations – 0,68±0,2 liter per day (p<0,05). A new device for reposition and fixation of the pelvic bones was proposed and introduced in clinical practice. It permits to operate the fragments position in three mutually perpendicular planes, ensures the stable bone fixation in different clinical situations, and permits to begin the motions in the hip joint in early postoperative period that promotes a quick recovery of pelvic organs function, cardiovascular and respiratory system.

The elaborated methods of pelvis injuries surgical treatment using the external fixation device, management of the patients with multiple and associated trauma have provided the positive results in 97,4% that permits us to recommend the proposed treatment system for these severe and complicated patients for wide use in practical traumatology.