Diagnostic and treatment features of concomitant injuries of pelvis and abdomen in the emergency traumatology

Abstract

Aim. Analysis of experience of treatment of patients with concomitant injuries of pelvis and abdomen in the emergency traumatology.Methods. Analysis of features of diagnosis and treatment of 77 patients with concomitant pelvic injuries admitted to Kazan City Clinical Hospital №7 was conducted.Results. The structure of concomitant pelvic injuries is characterized by a variety of injuries, often accompanied by severe shock. Concomitant pelvic injury in 74% of patients was accompanied by shock, and in 80% of cases it was II-III grade shock. To reduce the patient’s displacement in the admission ward full body CT scan was performed, and for clarifying the scope of injuries and tactics of management CT scan of injured organs was administered. During the first hour after admission to prevent dislocation of fractures and to stop intrapelvic bleeding external fixation devices in different modifications were used depending on the injury; that allowed stabilizing hemodynamics and condition of the victims. In the second step after stabilization of the patient’s state and hemodynamics and correction of homeostasis minimally invasive surgical interventions are recommended on day 5 to 7. If abdominal injury is identified, the optimal way of external fixation of fractures is C-type fixation frame, which allows adequate access for laparotomy.Conclusion. A patient with severe concomitant trauma needs urgent full body scan with subsequent X-ray CT, staging treatment based on the principal «Damage control», early fixation of pelvic fractures with the use of external fixation devices and subsequent minimally invasive osteosynthesis, and optimal external fixation device which allows adequate access in case of surgery.