OPTIMIZATION OF TREATMENT TACTICS FOR PATIENTS WITH COMBINED UNSTABLE INJURIES OF THE PELVIS AND LONG BONES OF THE LOWER LIMBS

Treatment of polytrauma patients with multiple fractures in general and «pelvis + lower extremities» in particular is a complex, topical and debatable problem today. Combined injury of the pelvis and TBI is observed in 16.9–58.7 % of cases, pelvis and lower limbs — in 49.2 %, pelvis and upper limbs — in 32.2 %, pelvis and chest organs — in 21.2–45.7 %, pelvis and bdominal organs — in 31.5–43.9 %, pelvis and spine — in 9 %. Objective. To improve treatment outcomes in patients with combined pelvic and lower extremity injuries by optimizing treatment tactics. Methods. The clinical study is based on the examination and treatment of 38 patients with combined injuries of the pelvis and lower extremities between 2014 and 2023. The average age of the patients was (41.4 ± 16.3) years. Typing of fractures of the pelvis and long bones of the lower extremity was carried out according to the AO classification, and the condition of patients was assessed according to the TS scale. Results. Guided by the provisions of the "damage control" concept, the nature of surgical interventions for victims with multiple and combined pelvic injuries can be presented in the following sequence: stabilizing, restorative, reconstructive, or reconstructive-restorative. Stabilizing surgical interventions are part of the resuscitation complex, the purpose of which is to preserve life by reducing pain reactions and blood loss. Conclusions. Unstable combined pelvic ring injuries require initial multidisciplinary treatment aimed at stopping or limiting life-threatening bleeding. The use of compressive devices (pelvic belt, Seattle technique) is a mandatory component of staged treatment. Individual treatment tactics and their extent depend on the overall condition of the patient, however, the basic principle of the first stage is to ensure the stability of the pelvis: in type B damage, of the anterior semi-ring, in type C damage, of both semi-rings, which has a positive effect on the anatomical and functional result and allows to avoid dangerous prognosis for life.