Pelvic fractures in combination with other segmental bone injuries at the polytrauma - possibilities of platelet-rich plasma application
Keywordspolytrauma, platelet-rich plasma, reparative regeneration, osteogenesis, bone remodeling, pelvic fractures
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.
Von Rüden C, Bühren V, Perl M. Polytraumamanagement – Behandlung des Schwerverletzten in Schockraum und OP [Polytrauma Management - Treatment of Severely Injured Patients in ER and OR]. Z Orthop Unfall. 2017 Oct;155(5):603-622. German. doi: 10.1055/s-0042-124275. Epub 2017 Oct 19. PMID: 29050055.
Mann SM, Banaszek D, Lajkosz K, Brogly SB, Stanojev SM, Evans C, Bardana DD, Yach J, Hall S. High-energy trauma patients with pelvic fractures: Management trends in Ontario, Canada. Injury. 2018 Oct;49(10):1830-1840. doi: 10.1016/j.injury.2018.06.044. Epub 2018 Jul 6. PMID: 29997027.
Caillot M, Hammad E, Le Baron M, Villes V, Leone M, Flecher X. Pelvic fracture in multiple trauma: A 67-case series. Orthop Traumatol Surg Res. 2016 Dec;102(8):1013-1016. doi: 10.1016/j.otsr.2016.08.018. Epub 2016 Nov 15. PMID: 27863917.
Toimela J, Brinck T, Handolin L. Evolution of high-energy pelvic trauma in southern Finland: a 12-year experience from a tertiary trauma centre. Eur J Trauma Emerg Surg. 2019 Sep 19. doi: 10.1007/s00068-019-01210-5. Epub ahead of print. PMID: 31538218.
Hsu SD, Chen CJ, Chou YC, Wang SH, Chan DC. Effect of Early Pelvic Binder Use in the Emergency Management of Suspected Pelvic Trauma: A Retrospective Cohort Study. Int J Environ Res Public Health. 2017 Oct 12;14(10):1217. doi: 10.3390/ijerph14101217. PMID: 29023379; PMCID: PMC5664718.
Höch A, Zeidler S, Pieroh P, Josten C, Stuby FM, Herath SC; German Pelvic Trauma Registry. Trends and efficacy of external emergency stabilization of pelvic ring fractures: results from the German Pelvic Trauma Registry. Eur J Trauma Emerg Surg. 2019 May 22. doi: 10.1007/s00068-019-01155-9. Epub ahead of print. PMID: 31119322.
Almahmoud K, Pfeifer R, Al-Kofahi K, Hmedat A, Hyderabad W, Hildebrand F, Peitzman AB, Pape HC. Impact of pelvic fractures on the early clinical outcomes of severely injured trauma patients. Eur J Trauma Emerg Surg. 2018 Apr;44(2):155-162. doi: 10.1007/s00068-016-0754-6. Epub 2017 Jan 13. PMID: 28091737.
Rossi LA, Murray IR, Chu CR, Muschler GF, Rodeo SA, Piuzzi NS. Classification systems for platelet-rich plasma. Bone Joint J. 2019 Aug;101-B(8):891-896. doi: 10.1302/0301-620X.101B8.BJJ-2019-0037.R1. PMID: 31362555.
Huang G, Hua S, Yang T, Ma J, Yu W, Chen X. Platelet-rich plasma shows beneficial effects for patients with knee osteoarthritis by suppressing inflammatory factors. Exp Ther Med. 2018 Mar;15(3):3096-3102. doi: 10.3892/etm.2018.5794. Epub 2018 Jan 24. PMID: 29599843; PMCID: PMC5867452.
Kapse S, Surana S, Satish M, Hussain SE, Vyas S, Thakur D. Autologous platelet-rich fibrin: can it secure a better healing? Oral Surg Oral Med Oral Pathol Oral Radiol. 2019 Jan;127(1):8-18. doi: 10.1016/j.oooo.2018.08.010. Epub 2018 Aug 31. PMID: 30287202.
Khatab S, van Buul GM, Kops N, Bastiaansen-Jenniskens YM, Bos PK, Verhaar JA, van Osch GJ. Intra-articular Injections of Platelet-Rich Plasma Releasate Reduce Pain and Synovial Inflammation in a Mouse Model of Osteoarthritis. Am J Sports Med. 2018 Mar;46(4):977-986. doi: 10.1177/0363546517750635. Epub 2018 Jan 26. PMID: 29373806.
Tischer T, Bode G, Buhs M, Marquass B, Nehrer S, Vogt S, Zinser W, Angele P, Spahn G, Welsch GH, Niemeyer P, Madry H. Platelet-rich plasma (PRP) as therapy for cartilage, tendon and muscle damage - German working group position statement. J Exp Orthop. 2020 Sep 3;7(1):64. doi: 10.1186/s40634-020-00282-2. PMID: 32885339; PMCID: PMC7471237.
Le ADK, Enweze L, DeBaun MR, Dragoo JL. Platelet-Rich Plasma. Clin Sports Med. 2019 Jan;38(1):17-44. doi: 10.1016/j.csm.2018.08.001. PMID: 30466721.
Castillo-Cardiel G, Medina-Quintana VM, Lomelí-Enríquez M. Plasma rico en plaquetas y su efecto en la regeneración ósea en fracturas mandibulares. Ensayo clínico controlado [Platelet-rich plasma and its effect in bone regeneration in mandibular fractures. Controlled clinical trial]. Gac Med Mex. 2017;153(4):459-465. Spanish. doi: 10.24875/GMM.17002574. PMID: 28991280.
Szponder T, Wessely-Szponder J, Sobczyńska-Rak A, Żylińska B, Radzki RP, Polkowska I. Application of Platelet-rich Plasma and Tricalcium Phosphate in the Treatment of Comminuted Fractures in Animals. In Vivo. 2018 Nov-Dec;32(6):1449-1455. doi: 10.21873/invivo.11398. PMID: 30348700; PMCID: PMC6365725.
Gunay S, Candan H, Yılmaz R, Eser I, Aydoğmus U. The Efficacy of Platelet-Rich Plasma in the Treatment of Rib Fractures. Thorac Cardiovasc Surg. 2017 Oct;65(7):546-550. doi: 10.1055/s-0036-1582261. Epub 2016 May 5. PMID: 27148928.
Singh R, Rohilla R, Gawande J, Kumar Sehgal P. To evaluate the role of platelet-rich plasma in healing of acute diaphyseal fractures of the femur. Chin J Traumatol. 2017 Feb;20(1):39-44. doi: 10.1016/j.cjtee.2016.03.007. Epub 2017 Jan 20. PMID: 28202370; PMCID: PMC5343097.
Wang D, Rodeo SA. Platelet-Rich Plasma in Orthopaedic Surgery: A Critical Analysis Review. JBJS Rev. 2017 Sep;5(9):e7. doi: 10.2106/JBJS.RVW.17.00024. PMID: 28953136.
Cheung EC, Hodax JD, Hsu WK, Williams SK, Smith HE, Lansdown DA, Feeley BT. Platelet-Rich Plasma, Bone Morphogenetic Protein, and Stem Cell Therapies. Instr Course Lect. 2020;69:273-288. PMID: 32017733.
Li SY, Zhou QS, Li Y, Chen C, Chen JQ, Zhou HL. [Autologous platelet-rich plasma combined with bone grafting in inducing membrane technology]. Zhongguo Gu Shang. 2019 Apr 25;32(4):302-307. Chinese. doi: 10.3969/j.issn.1003-0034.2019.04.003. PMID: 31027404.
Acosta-Olivo C, Garza-Borjon A, Simental-Mendia M, Vilchez-Cavazos F, Tamez-Mata Y, Peña-Martinez V. Delayed union of humeral shaft fractures: comparison of autograft with and without platelet-rich plasma treatment: a randomized, single blinded clinical trial. Arch Orthop Trauma Surg. 2017 Sep;137(9):1247-1252. doi: 10.1007/s00402-017-2736-5. Epub 2017 Jun 30. PMID: 28667397.
Canbeyli İD, Akgun RC, Sahin O, Terzi A, Tuncay İC. Platelet-rich plasma decreases fibroblastic activity and woven bone formation with no significant immunohistochemical effect on long-bone healing: An experimental animal study with radiological outcomes. J Orthop Surg (Hong Kong). 2018 May-Aug;26(3):2309499018802491. doi: 10.1177/2309499018802491. PMID: 30295139.
Leitner L, Gruber G, Lohberger B, Kaltenegger H, Leithner A, Sadoghi P. Klinische Anwendung von Platelet-rich plasma und Wachstumsfaktoren am Bewegungsapparat [Clinical administration of platelet-rich plasma and growth factors to the musculoskeletal system]. Orthopade. 2019 Jan;48(1):105-116. German. doi: 10.1007/s00132-018-3643-3. PMID: 30259059.
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