Pelvic fractures in combination with other segmental bone injuries at the polytrauma - possibilities of platelet-rich plasma application

Abstract

Introduction. The urgency of the problem of polytrauma is due to the constant increase in the number of road accidents, armed conflicts, terrorist acts, accompanied by the appearance of a large number of victims with severe and extremely serious injuries.

Purpose of study: to analyze the scientific literature and the results of our own experimental research and to summarize data on current trends and relevance of studying the main factors determining the development of disorders in victims with pelvic fractures in combination with multiple and combined injuries, to improve the prognostic criteria based on a comprehensive assessment of the clinical course of the disease and optimization of treatment by activating reparative regeneration of bone tissue with platelet-rich plasma.

Materials and methods. In the period from 2017 to2018 in the department of severe concomitant injury of the City Clinical Emergency and Medical Care Hospital of Zaporozhye, 35 patients with pelvic concomitant injury were operated. There were 19 men (54.29%) and 16 women (45.71%), aged from 23 to 77 years old, median – 39 years.

22 injured persons (62.86%) had road traffic injuries, 10 (28.57%) had household injuries, 2 (5.71%) had production injuries and 1 more (2.86%) had others. ISS scale less than 17 points was found in 20 patients (57.14%), from 17 to 25 – in 12 (34.29%), from 26 to 40 – in 2 (5.71%), more than 40 – in 1 (2.86%).

In all patients (100%) varying degrees of pelvic bone injuries were verified. These lesions of the pelvic ring were more often combined with fractures of the proximal femur with a traumatic brain injury - 17 cases (48.57%), with concomitant fractures of extremities of other localization - 12 (34.29%), with intraperitoneal injury - 11 (31.43%), with vertebral fractures - 9 (25.71%), with chest trauma - 6 (17.14%).

Results. In the main group of patients with treatment by platelet-rich plasma radiological visible adhesions of the key injured area in 8 weeks occurred in 10 people (83.33%). In 1 patient (8.3%) fusion occurred after 12 weeks and in 1 (8.3%) – 16 weeks after surgery. In the control group fusion at 8 weeks was detected in 14 patients (60.87%), in 8 patients (34.78%) – at 16 weeks.

Conclusion. Reliably substantiated data were obtained according to the results of the analysis of contingency tables 4*4 and the calculation of χ2 for the efficiency coefficient according to the Wald formula (Chi-square 6.87 with p=0.009), which indicate the best clinical positiveness of the technique with the additional introduction of platelet-rich plasma into the treatment regimen as part of assessing the dynamics of fracture consolidation processes in victims with multiple and concomitant injuries, which allows us to predict a favorable outcome in these patients.