STAGED TREATMENT OF PELVIC RING DISRUPTION IN THE POLYTRAUMATIZED PATIENTS

Pelvicring disruption (PRD) requires considerable forces and usually occurs in polytraumatized patients(pt). The purpose of this study is to analyze radiologic results and functional outcome of PRD in polytraumatized pt. Material and Methods: Of 226 pt with PRD, 78% (176) were polytraumatized, and they are the subject of this study. Mean age was 38.8 years (11.4–85.8). There were 102 men and 74 women. The cause of injury in 69% was traffic accident; fall from a great height in 16.4%; accident at work in 8.6% and miscellaneous in 6%. The incidence of involvement of other systems was: musculosceletal-78%; respiratory-58%; CNS-51%, intestinal-32%, urinary-14%; cardiovascular-8%. The average ISS was 34; 56 pt (32%) were haemodynamically unstable. According to M. Tile’s classification, 101 were found type B (B1-48; B2-30; B3-23) and 75 type C (C1-49; C2-18; C3-8). Perioperative mortality was 6% in B-type and 15% in C-type fractures. Immediate resuscitation started at admission and was followed by staged treatment. Life-saving surgery and provisional stabilization of pelvis were performed as a top priority (first stage). Management of associated lesions (second priority) was the next stage. The last stage was open reduction and internal fixation of PRD in 102 pt, external fixation in 46 pt and combined fixation in 28 pt. Results: X-ray follow-up results were excellent in 66%, good in 16%, fair in 10% and poor in 8%. The best X-rays results were in type B1-94%; B2/B3-76% and C-63%. Functional results were excellent in 48%, good in 32%, fair in 12% and poor in 8%. The best functional results were in type B2/B3 -90%; B1-73% and C-70%. Conclusion: Determination of priorities of surgery is essential in the management in polytraumatized patients with PRD especially in the early period. Reconstruction of PRD requires a staged approach. These findings are not only related to the stability and symmetry of pelvic ring, but also depend on the severity of soft tissue injury around the pelvis.