DOI: https://doi.org/10.22141/1608-1706.4.20.2019.178751

Features of pelvic fracture treatment in patients with mental disorders

O.V. Pelypenko, N.R. Didyk, O.S. Kovalov, А.V. Goncharov, S.N. Pavlenko, А.А. Bazhenov

Abstract


Background. The presence of mental disorders in a person can influence treatment approaches in musculoskeletal injuries. The preservation of the patient’s life and its further functional abilities depend on organization of optimal therapeutic measures in pelvic fractures in patients with mental illnesses. The purpose was to determine the features of the staged treatment of pelvic fracture patients who have mental disorders, to develop recommendations for the prevention of complications. Materials and methods. Data of 22 persons aged 18 to 79 years were used. In 18 patients (82 %), pelvic injury was a part of polytrauma. Mental disorders were found in 13.6 % of individuals who have been diagnosed with type C pelvic fracture (according to AO classification). The predominant causes of injury were road accidents (59 %), catatrauma (27 %). Fragment stabilization by the external fixation device as an element of anti-shock therapy was performed in 36 % of cases. Results. The data of blood test in the first hour are not informative and require close observation. Distinguishing factors of the traumatic disease course in patients with mental disorders were the rapid normalization of homeostasis and cyclical increase in blood glucose levels. A group of patients with type A fractures was treated conservatively. Orthopedic procedure with adequate anesthesia allowed normalizing the patient’s condition and, after intravenous therapy and hemodyna-mic control with appropriate recommendations for further treatment regimen, to discharge the patient for outpatient basis on days 4–7. Complications were not observed. Complications of the treatment detected in groups of patients with type B and C fractures were divided into 3 groups: those associated with the complexity of injury, the presence of concomitant pathological conditions and dependent on the patient’s behavior (compliance with the prescribed regimen). The management of patients with concomitant mental illness had distinctive features. The basic method for relieving exacerbation was the prescription of sedatives, which prevented the full implementation of the optimal functional treatment regimen. This approach significantly increased the risk of developing hypostatic complications (pressure ulcers, pneumonia, thrombosis). Refusal of sedation had risks of inappropriate patient’s behavior. With mental excitement, patients violated the sterility of wounds, removed the catheters by themselves, and loosened external fixation devices. Early wound infection complications did not allow performing a stable fixation of fracture fragments with internal structures as soon as possible. Temporary immobilization of the patient or creation of individual nursing station increased the risk of injury of the patient and medical staff. Conclusions. Post-traumatic exacerbation of mental illness requires additional measures of patients’ sedation for the prevention of recurrent suicide attempts, protection of external structures, ensuring the introduction of necessary medications, constant monitoring of the implementation of the rehabilitation regimen.

Keywords


pelvic fractures; mental disorders; rehabilitation

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