Iliosacral Screw Fixation in Patients with Polytrauma

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Abstract

The need to perform iliosacral fixation in patients with polytrauma and unstable pelvic injuries in the acute period of injury is still an unresolved issue. Minimally invasive techniques of pelvis internal fixation allow to perform single step reconstructive surgery in the acute period of the trauma.

Purpose — to evaluate the results of minimally invasive acute iliosacral fixation in patients with polytrauma and unstable pelvic injuries.

Materials and methods. The authors analyzed treatment outcomes in 105 patients with polytrauma and unstable pelvic injuries after iliosacral screw fixation in acute period. 69 (65.7%) patients had B-type and 36 (34.3%) patients had c-type of unstable pelvic injuries by AO/ASIF classification. Mean age was 35.5±11.7 years. The severity of injury on the ISS scale was 22.5±12.9 points. Ап patients underwent minimally invasive iliosacral fixation with screws in the acute period of the trauma.

Results. Patients classified according to the severity of their status as «stable» (n = 50) and «borderline» (n = 26) with stable hemodynamics (SAD >90 mm Hg) underwent minimally invasive iliosacral screw fixation of posterior pelvic ring straight in the anti-shock surgery. Injured classified as «unstable» (n = 15) and «borderline» (n = 14) with unstable hemodynamic parameters (SAD <90 mm Hg), who needed urgent large surgical procedures (laparotomy, thoracotomy et al.), underwent temporary pelvis stabilization by external fixation and/or c-frame, and as the hemodynamic parameters were stabilized iliosacral screw fixation within 48 hours from the moment of injury. The functional pelvis state in 58 patients by S.A. Majeed scale rated 90.7±11.2 points. The quality of life was assessed using the SF-36 questionnaire.

Conclusion. Restoration of the anatomical shape of the pelvic ring and its fixation, primarily posterior aspects, in the acute period of trauma allowed to obtain good anatomical and functional treatment outcomes in 94.9% of the patients with polytrauma.

About the authors

I. V. Kazhanov

Dzhanelidze Saint-Petersburg Research Institute of Emergency Medicine; Kirov Military Medical Academy

Author for correspondence.
Email: carta400@rambler.ru

Igor V. Kazhanov — cand. Sci (Med.), leading researcher, Department of combined Trauma, Dzhanelidze SРRIEM; head of Department, Military Field Surgery clinic, Kirov MMA

Russian Federation

V. A. Manukovskiy

Dzhanelidze Saint-Petersburg Research Institute of Emergency Medicine; Kirov Military Medical Academy

Email: fake@neicon.ru

Vadim A. Manukovsky — Dr. Sci (Med.), professor, deputy director for clinical work

Russian Federation

I. M. Samokhvalov

Kirov Military Medical Academy

Email: fake@neicon.ru

Igor M. Samokhvalov — Dr. Sci (Med.), professor, director of Military Field Surgery clinic, Kirov MMA.

Saint-Petersburg

Russian Federation

S. I. Mikityuk

Dzhanelidze Saint-Petersburg Research Institute of Emergency Medicine; Kirov Military Medical Academy

Email: fake@neicon.ru

Sergey I. Mikityuk — cand. Sci (Med.), senior lecturer, Educational center, Dzhanelidze SРRIEM; director of Department Military field Surgery clinic, Kirov MMA

Russian Federation

Ya. V. Gavrishchyuk

Dzhanelidze Saint-Petersburg Research Institute of Emergency Medicine

Email: fake@neicon.ru

Yaroslav V Gavrishchyuk — cand. Sci (Med.), the head, Department of Shock operating, Dzhanelidze

Russian Federation

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