O3012 PELVIC DISRUPTION (EMERGENT AND DEFINITIVE TREATMENT)

Abstract

Introduction: Hemorrhage in pelvic trauma may be life treatening. Emergent treatment obtaine the haemostasis and stop the bleading. The deþnitive treatment depend on the type of fractures and general state of patient. The purpose: of this study is to present our experiance in emergent and deþnitive treatment of pelvic disruption. Materials and methods: From 1982 to 2000, 212 pt. were treated with pelvic disruption. Of all pt. 186 were surgicaly treated with deþnitive stabilization. The other 26 pt. died. Of all pt. 72% were polytraumatized and 30% haemodinamically unstable. The average of ISS was 31. Assessment of pelvic instability was made by protocol which included: physical examination; radiographic assessment and CT of the pelvis. Classiþcation of the pelvic disruption was done according M. Tile. There were found 104 pt. with type B (B1-44; B2-37; B3-23) and 82 pt. with type C (C1-58; C2-14; C3-10). Emergent treatment of hemodynamic unstable pt. included: Intial resuscitation by polytrauma protocol, minimum diagnostic procedures, provisional stabilization of pelvis (Ex.Fx or pelvic stabilizator). Deþnitive stabilization was done by internal þxation in 87 pt., external þxation in 62 and combined þxation in 37 pt. X-rays follow-up results by Slatis were as excellent in 123 (66%); good in 33 pt. (18%); fair in 19 pt. (10%) and poor in 11 pt. (8%). Functional outcome results by DÔAubigne-Postel Scoring System were excellent in 89 pt. (48%); good in 60 pt. (32%); fair in 22 pt. (12%); poor in 15 pt. (8%). There were complication as a persistent sacroiliac pain in 12 pt.; impaired gait in 10 pt.; deep infection in 4 pt. and pin tract infection in 14 pt. Conclusion: Provisional stabilization of pelvic disruption should be viewed as part of pt. resuscitation. The results supports the deþnitive treatment of internal þxation in all type C pelvic fractures and pt. with severely type B injury.