Experience with the Use of Anti-Shock Cannulated Screws in Severe Pelvic Injuries

Background. In the structure of combined trauma, pelvic bone fractures occupy a significant part. Pelvic injuries are accompanied by the highest frequency of fatal outcomes than other injuries of the musculoskeletal system. The method of surgical treatment of pelvic bone fractures using cannulated screws is widely known among surgeons around the world and is successfully used for various categories of injuries. In some situations, this method is more advantageous in terms of restoring the stability of the pelvic ring, allows achieving greater interfragmentary compression, plays a significant role in stopping bleeding and serves as an effective anti-shock measure.

Aim of study. To propose a new approach and prove its effectiveness in the treatment of victims with severe combined pelvic trauma in the acute period of injury, consisting of the use of cannulated screws for minimally invasive immersion fixation of unstable pelvic ring injuries.

Materials and Methods. The article analyzes the treatment outcomes of 139 patients with unstable pelvic ring injuries treated in the I.I. Dzhanelidze St. Petersburg Research Institute of Emergency Care (level 1 trauma center) from 2016 to 2024, with signs of traumatic shock and ongoing intrapelvic bleeding. The patients underwent fixation of multiple pelvic bone fractures with cannulated screws upon admission to the anti-shock operating room. The following parameters were selected to assess the severity of the patients’ condition and the effectiveness of anti-shock measures: systolic blood pressure, body temperature, hemoglobin, red blood cell, hematocrit, platelet levels, coagulogram parameters (activated partial thromboplastin time, prothrombin time, prothrombin index, fibrinogen, international normalized ratio) and blood acid-base balance (pH, lactate, base deficit, and calcium ion concentration). In the group of patients under consideration, various combinations of sacroiliac screw placement were used: unilateral and bilateral placement, insertion into the body of S1 and (or) S2 vertebrae; and screws were installed in the supra-acetabular bone corridor (LC2 screws). The anterior pelvic half-ring was fixed both by immersion structures and by external fixation devices (combined osteosynthesis). Dependent samples were formed and indications were analyzed upon admission to the trauma center and 12 hours after surgery.

Results. Early minimally invasive fixation of unstable pelvic ring injuries with cannulated screws contributed to the cessation of intrapelvic bleeding, which was statistically significantly confirmed by the results of a comparative analysis of clinical and laboratory parameters. Thus, there was stabilization of hemodynamic parameters (systolic blood pressure increased from 90 to 120 mmHg, p<0.05), positive dynamics of changes in hemoglobin levels (increase from 69 to 89 g/l, p><0.05), improvement of acid-base balance and tissue perfusion (increase in pH from 7.292 to 7.382; restoration of base deficit from -4.05 to -0.9 mmol/l; decrease in lactate levels from 3.4 to 2.05 mmol/l, p><0.05), as well as normalization of blood coagulation system parameters (increase in the prothrombin index according to Quick from 71 to 81%; increase in the level of ionized calcium from 0.74 to 0.89 mmol/l, p><0.05). Additional methods of surgical hemostasis (extraperitoneal tamponade, angioembolization ) were used only in a limited number (13.5%) of victims with severe combined pelvic trauma. The immediate treatment results (mortality, complications, bed-day in intensive care and trauma center ) corresponded to the literature data, while in all discharged victims verticalization was achieved within 4 to 2 weeks after pelvic immersion fixation. CONCLUSION Early minimally invasive fixation of pelvic bone fractures with cannulated immersion screws in severe combined pelvic trauma is a safe and highly effective therapeutic measure that helps to finally stop intrapelvic bleeding, relieve traumatic shock, and improve hemodynamics and tissue perfusion. Minimally invasive fixation of unstable pelvic injuries with cannulated screws located at the level of the sacroiliac joints and supraacetabular corridor (LC 2 screw) is an effective way to combat shock in these patients. The achieved clinical results indicate the advisability of using this technique in the acute period of traumatic disease and are consistent with modern literature data on this issue. Keywords: unstable pelvic ring injuries, pelvic bone fracture, sacroiliac screws, minimally invasive osteosynthesis, traumatic shock, polytrauma> < 0.05), positive dynamics of changes in hemoglobin levels (increase from 69 to 89 g/l, p < 0.05), improvement of acid-base balance and tissue perfusion (increase in pH from 7.292 to 7.382; restoration of base deficit from -4.05 to -0.9 mmol/l; decrease in lactate levels from 3.4 to 2.05 mmol/l,p < 0.05), as well as normalization of blood coagulation system parameters (increase in the prothrombin index according to Quick from 71 to 81%; increase in the level of ionized calcium from 0.74 to 0.89 mmol/l, p < 0.05). Additional methods of surgical hemostasis (extraperitoneal tamponade, angioembolization ) were used only in a limited number (13.5%) of victims with severe combined pelvic trauma. The immediate treatment results (mortality, complications, bed-day in intensive care and trauma center ) corresponded to the literature data, while in all discharged victims verticalization was achieved within 4 to 2 weeks after pelvic immersion fixation.

Conclusion. Early minimally invasive fixation of pelvic bone fractures with cannulated immersion screws in severe combined pelvic trauma is a safe and highly effective therapeutic measure that helps to finally stop intrapelvic bleeding, relieve traumatic shock, and improve hemodynamics and tissue perfusion.

Minimally invasive fixation of unstable pelvic injuries with cannulated screws located at the level of the sacroiliac joints and supraacetabular corridor (LC 2 screw) is an effective way to combat shock in these patients.

 The achieved clinical results indicate the advisability of using this technique in the acute period of traumatic disease and are consistent with modern literature data on this issue.

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