A.F. LAZAREV, E.I. SOLOD, YA.G. GUDUSHAURI, E.I. KALININ, V.V. KONOVALOV, I.N. MARYCHEV

 National Medical Research Center of Traumatology and Orthopedics named after N. N. Priorov, Moscow

Contact details:

Kalinin E.I. — post-graduate student

Address: 10 Priorov St., Moscow, Russian Federation, 127299, tel.: +7-903-015-57-50, e-mail: Kalinin_evgeny@mail.ru

ORCID: https://orcid.org/0000-0003-2766-5670

 A surgical treatment of the joints of the pelvic ring, especially the pubic joint is a separate and complex problem. When using standard plates, which are applied in the treatment of patients with fresh injuries to stabilize old injuries of the pelvic ring, problems arise with fatigue fracture of plates, destabilization of the metal structure and the need for repeated surgical interventions. Therefore, in the case of old injuries, during surgical treatment, it is necessary to use other tactical approaches to fixing pelvic injuries and to search for adapted structures for such cases.

The purpose — to study the features of fixation of old injuries of the pelvic ring and to determine the results of different methods of the anterior pelvis fixation in old cases.

Materials and methods. A retrospective analysis of the performed surgical treatment was carried out. In 2000–2015, in the first department of National Medical Research Center of Traumatology and Orthopedics named after N.N. Priorov, 117 patients underwent surgical treatment of old injuries of the anterior pelvic ring under our supervision using standard reconstructive plates applied in the surgical treatment of new injuries of the pelvic ring.

Results. Of the 65 patients who underwent fixation of an old injury of the anterior semiring with AO reconstructive plates and AO pelvic plates, installed in a standard manner as in new injuries, 12 patients (10,2%) experienced migration or fracture of structures within 2 to 6 months from the operation. In 52 patients, fixation of the anterior section with two AO plates was applied, one of which was located in a standard way along the upper edge of the pubic bones, the second was implanted additionally along the anterior surface of the pelvic ring perpendicular to the first one. In this group, migration and destabilization of the structures was observed in 7 patients (13,4%) within a period from 2 weeks to 2 months from the date of the operation.

Conclusion. The analysis of the study results suggests that surgical treatment of old injuries of the anterior pelvic ring requires a special approach to the choice of the surgical fixation method, which differs from the treatment of new injuries. Over time, in the absence of treatment for injuries and ruptures of the pelvic ring, cicatricial-fibrous adhesions of the pelvic ring occur, which does not always ensure the stability of the pelvic ring, but leads to rigid post-traumatic deformity of the pelvis. Taking into account the cases of destabilization in groups 1 — 10,2% and 2 — 13,4%, as well as the assessment of the long-term results according to the Majeed scale, the use of standard methods for fixing the anterior pelvic semiring can be considered ineffective in old pelvic injuries.

Key words: pelvis, pelvic ring, old pelvic injury, osteosynthesis of pelvic bones.

REFERENCES

1. Thomas P. Ruedi; Richard E. Buckley, Christopher G. Morgan. AO-Principles of Fracture Management. Second expanded edition by AO Publishing. Switzerland, 2007. Pp. 696–717.
2. Robert R. Simon, Scott Sherman, Steven J. Koenigsknecht. Emergency Orthopedics. The Extremities, 2007, pp. 361–391 (in Russ.).
3. Tile M. Acute pelvic fractures: I. Causation and classification. J Am Acad Orthop Surg., 1996, vol. 4, pp. 143–151.
4. Dyatlov M.M. Slozhnye povrezhdeniya taza. Chto delat’? Rukovodstvo dlya vrachey i studentov [Complex injuries of the pelvis. What to do? A guide for doctors and students]. Gomel’: uchrezhdenie obrazovaniya «Gomel’skiy gosudarstvennyy meditsinskiy universitet», 2006. 496 p.
5. Tornetta P., Matta J.M. Internal fixation of unstable pelvic ring injuries. Orthop Trans, 1994, vol. 18, pp. 727–733.
6. Lazarev A.F., Gudushauri Ya.G., Kostiv E.P., Solod E.I., Kakabadze M.G., Roskidaylo A.S. Clinical aspects of complications of pelvic injuries. Tikhookeanskiy meditsinskiy zhurnal, 2017, no. 1, pp. 17–23 (in Russ.).
7. Stel’makh K.K. Treatment of unstable pelvic injuries. Travmatologiya i ortopediya Rossii, 2005, no. 4, pp. 31–38 (in Russ.).
8. Shlykov I.L. Surgical technique options depending on the type of pelvic deformity. Permskiy meditsinskiy zhurnal, 2009, vol. 26, no. 6, pp. 50–53 (in Russ.).