The structure, features and nature of combined pelvic injuries in victims in the level I trauma center of a St. Petersburg agglomeration

Abstract

Relevance. Mortality and unsatisfactory results of treatment of combined injuries of the pelvis, especially with pelvic ring fractures, are still high. This is due to the lack of an effective system of specialized medical care for this category of victims.Intention: To study the frequency, characteristics and structure of combined injuries of the pelvis with damage to the pelvic ring based on the experience of specialized medical care in the level I trauma center (St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine).Methodology. We analyzed the 10-year (2009–2018) treatment results for 932 victims with a combined pelvic injury at the level I trauma center: St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine. In the study group, 667 victims had unstable pelvic ring injuries.Results and Discussion. Combined injuries of the pelvis, accompanied by damage to the pelvic ring in a large urban agglomeration as a result of high-kinetic injuries (road traffic injury, catatrauma, etc.) were observed in 16.3% of the structure of polytrauma. 75.8% of the victims were of working age. In the structure of injuries, pelvic ring injuries among polytrauma mainly resulted from traffic accidents (57.9 %). The initial fractures were classified as stable type A (265; 28.5 %), partially stable type B (485; 52 %), and vertically unstable type C (182; 19,5 %) according classification М. Tile и М.Е. Muller (AO/ASIF). Four or more areas of the body were affected int 60.8 %, and pelvic injuries dominated in 62.8 % of observations. Half of the patients with pelvic ring injury were diagnosed with more than 25 points by the ISS. Among them, life-threatening complications were identified in 77.7 %. Of these, 33.6 % had pelvic bleeding, the second largest source of acute blood loss was intra-abdominal – 12 % of observations. The mechanism of damage to the pelvic ring was lateral compression (LCI) – 54 % and vertical shift – 57.7 %. In the structure of morphological damage to the posterior pelvic ring, unilateral and bilateral fractures of the sacrum were more common: 51.7 and 13.2 %, respectively. Multiple pelvic injuries was diagnosed in 7.3 % of victims, most had ruptures of the bladder and posterior urethra; open pelvic injuries, including extensive traumatic skin detachment were observed in a small percentage of observations (3.4 %).Conclusion. Unstable pelvic ring injuries differ from other types of pelvic injuries due to more common (33.1 %) traumatic shock (grade III traumatic shock) and greater acute blood loss (> 20 % blood volume; 35.9 %), especially in victims with vertically unstable pelvic injuries. This requires rapid transportation of the victim to the trauma center, proper organization of pre-hospital care, including temporary fixation of the pelvis and early specialized medical care.