POTENTIAL OF PLATELET-RICH PLASMA APPLICATION FOR PATIENTS WITH PELVIC FRACTURES IN COMBINATION WITH OTHER SEGMENTAL BONE INJURIES IN POLYTRAUMA
Authors: Ivchenko D.V. , Trufanov I.I. 
Published: February 2019

The relevance of issues on polytrauma is determined by the constant increase in the number of road accidents, armed conflicts, terrorist acts, accompanied by the appearance of a large number of casualties with severe and extremely serious injuries. The purpose of study was to analyze the recent reports of relevant scientific literature and the results of our own experimental research 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 enhance the prognostic criteria based on a comprehensive assessment of the clinical course of the disease and to improve the treatment by promoting reparative regeneration of bone tissue with platelet-rich plasma. Materials and methods.Through the period from 2017 to 2018, 35 patients with polytrauma were operated on at the Traumatology Department of the Municipal Clinical Emergency and Medical Care Hospital of Zaporizhzhia. Among the patients there were 19 men (54.29%) and 16 women (45.71%) aged from 23 to 77 years, mean age was 39 years. 22 persons (62.86%) had road traffic injuries, 10 (28.57%) had domestic injuries, 2 (5.71%) had occupational injuries and 1 patient (2.86%) had other type of traumas. ISS scale injury less than 17 scores was found in 20 patients (57.14%), injuries varying from 17 to 25 scores – in 12 (34.29%), from 26 to 40 scores – in 2 (5.71%), and injury assessed as more than 40 scores was found in 1 (2.86%) patient. All patients (100%) were verified to have pelvic bone injuries varying degrees. The injuries of pelvic girdle were more often combined with fractures of the proximal femur against the background of traumatic brain injury and were diagnosed in 17 cases (48.57%); the same type of trauma with concomitant fractures of extremities of other localization was detected in 12 cases (34.29%). There were diagnosed 11 cases (31.43%) of above mentioned traumas complicated with intraperitoneal injury, 9 cases (25.71%) complicated with vertebral fractures, and 6 cases (17.14%) complicated with chest trauma). Results and discussion. In the main group of patients receiving the treatment with platelet-rich plasma, radiologically visible union of the injured area developed in 10 people (83.33%) in 8 weeks. 1 patient (8.3%) developed the synosteosis in 12 weeks and 1 patient (8.3%) developed synosteosis in 16 weeks following the surgery. In the control group fusion was detected in 14 patients (60.87%) in 8 weeks and in 8 patients (34.78%) in 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) that indicates better clinical effectiveness of the technique due to the additional introduction of platelet-rich plasma into the treatment mode in order to assess the dynamics of fracture consolidation processes in victims with multiple and concomitant injuries. The results obtained allow us to predict a favourable outcome in these patients.