A differential approach in the treatment of patients with unstable combined pelvic injuries

Background. The patients with unstable combined pelvic injuries account for 10 to 20 % in the group with polytrauma and multiple organ injuries. The majority are males (76.5 %) with an ­average age of 41 ± 12 years, who are characterized by a high severity score on the ISS and a mortality rate ranging from 8 to 15 %. The modern treatment strategy for these patients is based on the concepts of damage control surgery and damage control orthopedics. Consi­dering the variability of combined injuries in anatomical regions, there is an urgent need to deepen knowledge to develop and implement treatment strategies for various types of these injuries. The purpose was to improve treatment outcomes for patients with combined pelvic injuries by optimizing treatment strategies and introduction of the latest surgical technologies. Materials and ­methods. The clinical study is based on the examination and treatment of 157 patients with unstable combined pelvic injuries. The study group included 95 patients treated according to the developed treatment algorithm, which involved the use of a proposed fixation device for stabilizing injuries in the sacroiliac joint region in type C fractures. The control group consisted of 62 patients treated by traditional diagnostic and treatment approaches. Results. In the study group with type B pelvic injuries combined with fractures of the long bones of the lower limbs, excellent and good functional outcomes were observed in 20 (76.9 %) patients compared to 8 (49.1 %) in the control group. Unsatisfactory outcomes were noted in 2 (7.7 %) and 2 (11.8 %) cases, respectively (р < 0.05). For type C injuries, excellent and good outcomes were observed in 8 (66.6 %) patients in the study group compared to 4 (50.0 %) in the control group. Unsatisfactory outcomes occurred in 1 (8.4 %) and 1 (12.5 %) cases, respectively (р < 0.05). In unstable type B pelvic injuries combined with chest trauma, excellent and good functional outcomes were observed in 19 (78.2 %) patients in the study group compared to 10 (62.5 %) in the control group. Unsatisfactory outcomes were noted in 1 (4.2 %) and 2 (12.5 %) cases, respectively (р < 0.05). For type C injuries, excellent and good outcomes were observed in 8 (66.6 %) patients in the study group and 4 (50.0 %) in the control group, with unsatisfactory outcomes in 1 (8.4 %) and 1 (12.5 %) cases, respectively (р < 0.05). Regarding patients with type B pelvic injuries combined with abdominal organ injuries, 18 months after the trauma, excellent and good functional outcomes were observed in 11 (78.6 %) patients in the study group and 5 (55.5 %) in the control group. Unsatisfactory outcomes occurred in 1 (7.1 %) and 2 (11.1 %) cases, respectively (р < 0.05). For type C injuries, excellent and good outcomes were noted in 6 (66.6 %) patients in the study group and 2 (50.0 %) in the control group. Unsatisfactory outcomes were recorded in 1 (11.1 %) and 1 (25.0 %) cases, respectively (р < 0.05). Conclusions. The proposed differential treatment strategy, based on the developed algorithms incorporating the principles of damage control surgery and damage control orthopedics, the implementation of new methods to stabilize the posterior pelvic ring, and an active approach to fixation conversion have significantly improved functional outcomes in the treatment of unstable combined pelvic injuries.