From the appearing of the first works of R. Judet, E. Letournel, M. Tile up to this day, the methods of pelvic surgery changed cardinally. These operations are technically complicated and accompanied by blood loss. That’s why the low-invasive surgical methods including endoscopic approach are perspective.

The endoscopic methods of reposition and osteosynthesis offer advantages which are expressed in increasing of injury visualization, reduction of surgical incisions and fast postoperative restoration. A surgeon using the method of osteosynthesis needs endoscopic skills and thorough knowledge of standard surgical approaches.

We have the experience of the treatment of 12 patients. We consider that the indications for these operations are not only a type of pelvic injury, but also anatomico-technical moment: an opportunity of creating of workspace.

We have 2 techniques:

endoscopic osteosynthesis with using of pelvioscope;

In any case, it is necessary to create the workspace from a small incision above the injury region by the method of tissue pneumotization. Fracture reposition is realized using a fracture table and reducing attachments. Osteosynthesis is immediately carried out with both standard and original steel constructions using the special tools that we developed and produced (ports, drill, screwdrivers etc.). The intraoperative blood loss was not more than 150 ml in all cases and in the postoperative period in drains–not more than 100 ml. The promotion of the patients was realized by the standard methods. There were no complications. The good functional result was in all cases.

We think that further development of such techniques will allow to activate pelvic surgery on the new qualitative level.

Materials and methods: We treated 415 patients with pelvic fractures. According to the classification of M. Tile, the fractures were allocated in the following manner: A-40%, B-31%, C-29%. 46% of these patients were admitted with different rates of severity of the shock state. Osteosynthesis was carried out in 51% cases: 27%- the external fixation only, 10%–internal constructions only and 14%–combined synthesis. The treatment of pelvic fractures must correspond to the requirements of anti-shock measures and to the treatment of intra-articular lesions. The most informative method of the radial diagnosis is CT examination with three-dimensional pelvic reconstruction. We oriented toward the severity of pelvic lesion (A, B, C) for the determination of the terms, the volume and the order of surgical interventions. We carried out the total volume of surgical interventions in the consideration of the severity of pelvic lesions in the shock of I and II rates. We used the internal or combined osteosynthesis in the partial or total loss of pelvic stability (B and C types). Internal osteosynthesis of the pelvis is biomechanically substantiated, because it regains the circular form, consequently, the pelvic stability too, it decreases the hemorrhage from the fractures regions, removes the pain more rapidly. Hemorrahage compensation was realized by intraoperative autohemotransfusion. In case of another dominant lesion, we operated by means of two brigades. In the shock of III and IV rates we carried out the pelvic stabilization only by the external fixation apparatus for the improvement of common state of the patient. The closed reposition and the osteosynthesis by external fixation apparatus with anterior frame do not ensure completely in the fractures of type C, but it is the most rapid method to obtain and to maintain of reposition in the future.

Results: Functional results were appreciated at the moment of discharge and after 12 months according to Majeed S.A. scale (1989) and according to data of computerized optic topography to appreciate the postural balance. Good and excellent results (70–100 points for the workers and 55–80 points for non-workers) were in 49% patients at the moment of discharge and in 82% patients after 12 months. Lethality value was 5,3%. Invalidism value was 6,9%. The mean terms of hospital stay were 32 days and the mean terms of resuscitation department stay were 1,5 days.

Conclusion:

The treatment of the patients with severe injuries of pelvis in polytrauma must be realized in special clinics, with necessary equipment and specially prepared nursing.