The nature and structure of pelvic area damage in patients with polytrauma andunstable pelvic ring
The goal: to investigate the nature and structure of the pelvic area injury (PAI) in casualties with severe concomitant injury and unstable pelvic ring.
The methods: the medical records of 406 casualties (157 survivors, 249 dead) with an unstable pelvis injury in polytrauma were analyzed. The severity of the injury was assessed according to the integral scales ISS, PTS, ATS. The conclusion forensic examinations were studied for the dead.
Results: among different types of injury traffic accident (245; 60.3 %) and household injuries (136; 33.5 %) were predominated, from point of view of injury genesis — catatrauma (150; 36.9 %). Unstable pelvic injuries in polytrauma were diagnosed more than half of patients with PAI with a predominance of rotationally unstable fractures (type B) — 307 (75.6 %). Vertically unstable lesions (type C) were observed in 99 (24.4 %) cases. Concomitant acetabular fractures were observed in 11.8 % of patients, damage to the pelvic organs (PO) — in 24.1%. Among PO following ruptures were detected: bladder — 48 (11.8 %), urethra — 27 (6.7 %), rectum — 5 (1.2 %),uterus and ovarian — 3 (0.7 %), great vessels — 5 (1.2 %), several PO — 10 (2.5 %). The severity of the damage of the different anatomical regions (AR) according to the scales ISS, PTS, ATS in group of survivors and deaths did not differ significantly (p > 0.05),but from the point of view of general severity of injury the differences between the groups were significant (p < 0.05). Lethal outcome was recorded in 249 cases (61.3 %). The greatest number of casualties died at 1–3 days post-injury — 185 cases (74.3 %); 4–10-days — 42 cases (16.9 %), 10 days after trauma and more — 22 cases (8.8%). In 72 28.9 %) cases, the results of forensic medical examination did not match the final diagnosis of damage severity of pelvic ring injury.
Conclusions: unstable pelvic injury (type B and C) in patients with polytrauma was identified in 51.9 %of cases, while rotationally unstable fractures (type B) — 2/3. Vertically unstable fracture (type C) increases the risk of death by almost two times. Crucial to survival prognosis in polytrauma has a number of damaged AR due to the development of mutual burdening syndrome.
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