Treatment of children with pelvic polytrauma with minimally invasive and combined osteosynthesis techniques

Introduction Pelvic fractures in children are rare but extremely severe injuries associated with a significant threat to life. The search for new rational tactics of their surgical treatment based on a combination of various minimally invasive osteosynthesis techniques and instruments for its implementation remains relevant.The aim of the work was to evaluate the results of staged treatment and a combination of minimally invasive osteosynthesis techniques at different periods of traumatic disease in children with combined and multiple pelvic injuries.Materials and methods An analysis of 48 cases of treating pelvic ring fractures in children who sustained combined and multiple injuries within the period of 2000 to 2023 was carried out. The study group included 23 children treated at the pediatric polytrauma center of the Amur Regional Children's Clinical Hospital, in whom the author's methods and instruments were used for anti-shock and final osteosynthesis of the pelvic ring. The comparison group included 25 patients treated at the Republican Scientific Center for Emergency Medical Care (Tashkent). The comparison group was divided into three subgroups based on the treatment method: conservative treatment, osteosynthesis with pins, osteosynthesis with an external fixation device (EFD). Pelvic fractures were classified according to AO/ASIF; the severity of polytrauma was assessed according to the ISS scale. Anatomical and functional treatment results were evaluated using the methods of I.L. Shlykov and S.A. Majeed.Results In patients of the main study group, residual displacement was observed by 57.6 % less frequently than in the subgroup with conservative treatment, by 32.6 % than in the subgroup with wire osteosynthesis and by 15.9 % than in the subgroup with osteosynthesis with an external fixation device (EFD). The functional treatment result of patients in the main study group was significantly better than in the subgroups of conservative treatment and wire osteosynthesis of the comparison group, with no significant difference when compared with the subgroup of EFD osteosynthesis.Discussion Staged combined treatment using developed techniques and metal structures for osteosynthesis allows better reduction and stabilization of pelvic ring fractures and achieves good functional results. Not all problems of pelvic surgery can be solved with EFD; a number of injuries require the use of internal osteosynthesis for more accurate reduction. Disintegrating pelvic injuries accompanied by complete bilateral instability should be operated using temporary transpedicular fixation, since there is no alternative to this method.Conclusion The combination of external fixation with internal osteosynthesis provides accurate reduction and reliable stabilization of pelvic ring fragments. Staged specialized care including internal bleeding arrest and fixation with an anti-shock device at the first stage and final stabilization of pelvic ring fragments at the second stage is the most rational tactical approach to polytrauma in children. External fixation can be used not only as a reliable and simple anti-shock fixation, but also as a method of final osteosynthesis.