A CLINICAL CASE OF SURGICAL TREATMENT OF AN UNSTABLE FRACTURE OF THE CERVICAL SPINE IN COMBINATION WITH AN UNSTABLE-ROTATIONAL FRACTURE OF THE PELVIC BONES
A one-stage violation of the stability of the cervical spine and the support of the pelvic ring with a direct impact are extremely life-threatening displacements, combined with neurological deficits and massive bleeding, which determine high mortality. Treatments for these injuries in isolation are controversial. In combination, they are indefinite due to their extreme rarity and high lethality. Objective - to estimate the results of treatment with anterior stabilization technique in a patient with the hangman's fracture according to Levine and Edwards and possibilities of apparatus treatment technique for unstable pelvic injury. Materials and methods. The analysis of successful observation of unstable injuries to the pelvis and cervical spine was performed. Patient S., 33 years old, case history No. 16352, was admitted after an injury as a result of the collapse of a metal structure on 14.07.19. He was delivered to Republican Traumatology Center by relatives in a passenger car without immobilization. Diagnosis: Polytrauma. Closed comminuted fracture of the posterior part of the right iliac bone, rupture of the right sacroiliac joint, rupture of the pubic symphysis with dislocation of the right hemipelvis. Fracture-dislocation of the C2 vertebra anteriorly, fracture of the arches and articular processes of the C2-C3 vertebrae, with severe pain and radicular syndrome. Results and discussion. Treatment of unstable trauma of the pelvis and cervical spine in the acute period is controversial among clinicians due to the rare opportunity to provide assistance and undeveloped effective tactics and strategies for managing these patients. We are categorically opposed to the installation of the C-frame, with a fracture of the sacrum and posterior parts of the pelvis, which can be diagnosed clinically. The patient underwent combined treatment, stabilization and primary reduction of the pelvis with an external fixation apparatus with the possibility of hardware reduction and after reduction and skeletal traction on the 8th day, submerged stable fixation of the cervical spine. Conclusion. Treatment outcomes are almost always unfavorable, which determines the relevance of the study of each particular case of injury, the options for their treatment, and the particularities of further assistance - this will subsequently allow developing a unified tactics for managing such severe injuries. Own successful case of treatment of unstable injuries is presented. Timely and high-quality surgical treatment in a victim with unstable fractures of the pelvis and cervical spine (hangman type III), adequately matched for these injuries, ensured a favorable outcome in the near and long term period.