The purpose of the work was to improve the treatment results for patients with complicated pelvic injury using differentiated application of transosseous and internal osteosynthesis. Retrospective analysis of treatment results is presented for 52 patients with vertically unstable pelvic ring injuries and concomitant abdominal injuries. Clinical cases demonstrate the variants of clinical decision depending on the type of injury, degree of pelvic ring instability, pattern of concomitant abdominal injuries. Protocol of patient management in such injuries is suggested.

Purpose To assess the effectiveness of minimally invasive technologies of osteosynthesis and electromagnetic waves of the terahertz range in patients with multiple and concomitant trauma. Materials and methods The process of rehabilitation was studied in 513 patients with polytrauma of varying severity which was more than 26 points on the ISS scale. The patients were diagnosed with 545 injuries of different organs and systems. All patients with severe concomitant and multiple trauma were divided into 3 groups: Group I of controls, treated in1995–2001, consisted of 269 patients whose treatment was conservative and aggressive (surgical, with the use of plating or intramedullary osteosynthesis); Group II was the experimental study group consisting of subgroup A of 202 patients treated in 2002–2009 in whom “damage control” concept was applied and subgroup B of 42 patients treated in 2010–2017 using the damage control tactics and new minimally invasive methods of treatment and devices (non-invasive lung ventilation in intensive care for fat embolism; rational osteosynthesis in closed chest trauma; minimally invasive guided method of transosseous osteosynthesis, including the use of fixators with hydroxyapatite coating; rational surgical approach to pelvic bones; universal guide for reaming the medullary canal) and exposure to electromagnetic waves of the terahertz range (EMWTHR)of the xiphoid process of the sternum to stimulate the immune system. Results It was revealed that the use of minimally invasive, low-traumatic methods of treating bone fractures in severe polytrauma and methods stimulating the immune system and tissue regeneration (subgroup II B) contributed to an improvement of anatomical and functional results of treatment by 1.3 times compared with the control group. The quality of life of patients in this group, in comparison with the control group, was 1.6 times higher for injuries of the upper limb and 1.9 times higher for injuries of the lower limb. An integral analysis of the effectiveness of the treatment revealed a reliable increase in the effectiveness to a satisfactory level. Conclusion The use of EMWTHR in the complex treatment of such patients is a promising method for stimulating hematological and immunological processes. The first results described in the literature are optimistic.

Introduction Improving the results of treatment and rehabilitation is essential for polytrauma patients. The aim of the study was to prove the effectiveness of terahertz electromagnetic waves (TEW) in polytrauma patients early after traumatic event to improve immune parameters. Material and methods The study included 20 polytrauma patients who were divided into two groups. Patients of the treatment group (n = 10) received TEW early after traumatic event in addition to standard treatment using the damage control approach. Control patients (n = 10) received no TEW therapy in the complex of therapeutic measures. Immunological studies were performed during treatment. The effectiveness of rehabilitation was assessed at a long term using an evaluation scale. Results The mean rehabilitation score was significantly higher in the treatment group compared to the controls. The treatment group showed significantly higher production of TNFα and IL-2, spontaneous production of IFNγ by lymphocytes, phagocyte activity (NBT-test) and absorption activity of monocytes after the use of TEW in comparison with controls. An increased level of IgG and IgM was also noted in patients of the treatment group. Discussion The findings showed that the use of TEW in polytrauma patients early after traumatic event resulted in the increase in cytotoxic activity of lymphocytes and phagocytic cells. The immunostimulating effect of TEW was also achieved through boosting humoral immunity. Conclusion The TEW used early after traumatic event in polytrauma patients resulted in strengthening of the immune system which contributed to more effective rehabilitation.