Vladimir Kusturov^1,3 and Anna Kusturova^2,3*

¹Department of Surgery No. 1 “Nicolae Anestiadi” and Laboratory of Hepatic-Pancreatic-Biliary Surgery, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Republic of Moldova
²Department of Orthopedics and Traumatology, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Republic of Moldova
³Laboratory of Polytrauma, Institute of Emergency Medicine, Chisinau, Republic of Moldova

*Corresponding Author: Anna Kusturova, Assistant Professor, Researcher, Department of Orthopedics and Traumatology, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Republic of Moldova.

Received: April 26, 2021; Published: May 06, 2021

Abstract

Introduction: Associated injuries of the pelvic ring and the organs of the pelvic cavity are a complex problem in emergency surgery. The difficulties are explained by the fact that these lesions develop as a result of severe trauma, accompanied by significant injury of the organs and tissues within this area and traumatic shock development, that require the active participation of a multidisciplinary team, such as traumatologist, urologist, surgeon and anesthesiologist reanimatologist.

Aim: To determine the particularities of minimally invasive external osteosynthesis in the treatment of pelvic fractures with associated urinary tract injuries.

Materials and Methods: Prospective study included the analysis of treatment outcomes in 59 trauma patients with fractures of the pelvic ring and urinary organs lesions. There were 55 males and 4 females, including a pregnant woman in the third trimester of pregnancy. Mean patient age was 41,34 ± 2,66 years (p < 0,05). At hospitalization, 52 patients were diagnosed with shock. 47 patients suffered traffic accident, 9 - fall from height and 3 - massive wall collapse. According to the AO/ASIF classification pelvic fractures, type A were identified in 6.77% (n = 4) cases, type B - in 31 (55.93%) patients, type C - in 22 (37.3%) patients, all of them being hemodynamic unstable. Urinary organs were damaged in all 59 cases. Urinary bladder contusion was diagnosed in 21 (35,59%) patients, bladder wall lesions - in 30.58% (n = 38), urethral ruptures - in 18.64% (n = 11), in 7 cases bladder rupture was associated with kidney injury. Long tubular bone fractures were found in 54.23% (n = 32) cases. Associated chest trauma - in 35 patients, craniocerebral trauma - in 27 patients, abdominal organ injuries - in 10 patients. The severity of lesions according to ISS scale ranged from 17 to 51 points (mean 35,03 ± 14,97).

The initial management of the patients with pelvic fractures included antishock measures - bleeding stopping, perfusion and transfusion therapy, pelvic ring stabilization.

Results: In this study the main tactical aspects in trauma patient care were identified, such as patient stabilization, preliminary fixation of the pelvic ring with an external device, urinary bladder repair and drainage and control over pathological accumulation of urine in the pelvic cavity.

Conclusion: The sequence of urgent treatment measures in trauma patients with pelvic injuries associated with urinary tract lesion was identified; in addition, the problems that require further investigations and may improve the clinical outcomes were determined. Preventive treatment outcomes in these patients indicated that adequate and early surgical correction of the pelvic ring with an external fixation device and urinary bladder repair is possible in almost all cases. Realization of this goal requires special equipment, qualified and properly trained personnel.

Keywords: Pelvic Fracture; Osteosynthesis; Associated Injuries

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