Operative treatment of combined fractures of pelvic bones and lower extremities

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The experience of surgical correction for combined injuries of pelvic bones and lower limbs was presented. There were 44 patients: 24 patients with acute trauma including 10 patients with injuries of the inner organs; and 20 patients with posttraumatic deformities and other sequela. Fractures of lower limbs (mainly femur and crus) were combined in 79.5% of cases with polyfocal injuries of pelvic ring and in 20.5% of cases with monofocal ones. Others’ technique of transosseous osteosynthesis for femur and crus fractures as well as closed reposition and pelvic ring stabilization was of relative simplicity and minimal trauma and allowed to perform lower limb fracrure osteosynthesis independently of the number of injured segments and fracrture number as well as to perform the operation by several teams simultaneously. Authors considered the following tactic as rational: 1) closed simultaneous reposition of pelvic ring and lower limb fractures may be performed on the day of patient’s admission; 2) delayed open surgical correction with combination of transosseous osteosynthesis may be performed simultaneously in the pelvic ring and lower limbs; 3) open surgical correction of pelvic ring and lower limbs may be performed separately and step-by-step.

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D. Cherkes-Zade

Central Institute of Traumatology and Orthopedics named after N.N. Priorov

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Email: info@eco-vector.com
俄罗斯联邦, Moscow

V. Chelyapov

Central Institute of Traumatology and Orthopedics named after N.N. Priorov

Email: info@eco-vector.com
俄罗斯联邦, Moscow

A. Lazarev

Central Institute of Traumatology and Orthopedics named after N.N. Priorov

Email: info@eco-vector.com
俄罗斯联邦, Moscow

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2. Fig. 1. Direct survey anteroposterior radiograph of the pelvis (a) and radiograph of the right leg (b) of patient B. at admission. a - rupture of the pubic symphysis with diastasis up to 6 cm and the left sacroiliac joint; b — multifragmented double open fracture of the leg bones.

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3. Fig. 2. Radiographs of the same patient after surgery on the day of admission. a — stabilization of the pelvic ring with an external fixation device: closed reposition, the configuration of the pelvic ring is restored; b — external transosseous osteosynthesis of a tibial fracture using the Ilizarov apparatus.

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4. Fig. 3. The same patient 5 weeks after the operation: walks with full load, without additional means of support.

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5. Fig. 4. Direct survey anteroposterior radiograph of the pelvis of the same patient 2 months after surgery: the external fixator was removed, the correct configuration of the pelvic ring in the area of damaged joints was preserved.

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