Analyzing Reasons of Fatal Outcomes Among Victims with the Unstable Pelvic Injuries in Роlytrauma

N.L. Аnkin, V.V. Burluka, M.A. Maksymenko, A.V. Pastushkov

Abstract


The analysis of treatment and the conclusions of forensic medical examinations in 384 patients with unstable pelvic injuries in polytrauma (ISS ≥ 17 points) who died in Municipal clinical emergency hospital (Kyiv) in 2000–2012 has been carried out. Type B pelvic injuries occurred in 232 (60.4 %), type C — in 152 (39.6 %) patients. Mean age of patients was 41.8 ± 6.8 years, 249 (64.8 %) were men, women — 135 (35.2 %). In 68.8 % of fatal outcomes, along with unstable pelvic injuries, 3 or 4 anatomical areas were damaged. On the first day after admission 242 (63 %) patients died, the rest — 142 (37%) — in terms of more than a day. Analysis of the findings of forensic medical examinations showed that in 24 (6.3%) cases a mismatch between the more mild pelvic injury clinicoroentgenologically and more severe has been found in autopsy; in 8 (5.8 %) patients who lived more than day, no pelvic bone injuries were found. At prehospital stage in 47.2 % of died from massive blood loss, intensive therapy was not given at all. Among patients with unstable pelvic injuries in polytrauma, who have lived more than a day, for 2–5 hours after admission, external fixation device was applied in 36 (45.6 %), Ganz frame— in 8 (42.1 %), and in 5 — extraperitoneal pelvic tamponade. The level of prehospital mortality is greatly influenced by the quality of intensive care, the delivery time to the hospital, at the hospital — the number and severity of injuries of other anatomical regions, the type of instability of the pelvic ring, the age of the victim, the quality of diagnosing and speed of operational interventions to stop intracranial, intrapleural, intra-abdominal and intrapelvic bleeding.


Keywords


роlytrauma; unstable pelviс injury; mortality

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DOI: https://doi.org/10.22141/1608-1706.2.15.2014.81369

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