DOUBLE PELVIC FRACTURES: CLINICAL CHALLENGES AND MANAGEMENT

Аннотация

Double pelvic fractures are rare but life-threatening injuries commonly associated with high-energy trauma. They are characterized by bilateral or combined disruptions of the pelvic ring leading to severe instability and massive hemorrhage. Early diagnosis with CT imaging and rapid hemodynamicstabilization are critical. Double pelvic fractures are among the most severe injuries encountered in trauma care, as they compromise the pelvic ring at multiple points, leading to significant biomechanical instability andhigh risk oflife-threatening hemorrhage. These injuries are frequently associated withhigh- energy mechanisms such as motor vehicle collisions, industrial accidents, and falls from significant heights. The complex anatomy of the pelvis, combined with the proximity of major blood vessels and visceral organs, makes bilateral pelvic fractures a critical emergency requiring immediateand coordinated intervention. In addition to mechanical instability, double pelvic fractures are strongly correlated with damage to the genitourinary tract, abdominal organs, and neurovascular structures, which complicates management and increases morbidity and mortality. Early diagnosis through radiographic and CT imaging is essential for accurate classification and surgical planning. The main goals of management include rapid hemodynamic stabilization, hemorrhage control, and restoration of pelvic stability using external fixation or C-clamps, followed by definitive reconstructionwhen thepatient’s conditionallows. This study aims to highlight the clinical challenges, diagnostic strategies, and treatment outcomes of patients with double pelvic fractures, emphasizing the importance of a multidisciplinary approach to improvesurvival rates and long-term functional recovery. Methods: A retrospective analysis of 20 patients with confirmed double pelvic fractures treated between 2019 and 2023 was performed. Inclusion criteria included bilateral or combined disruptions of the pelvic ring confirmed on CT imaging. Data collected included demographic characteristics, mechanism of injury, hemodynamic parameters, associated organ damage, and treatment modality. All patients underwent standard trauma assessment based on ATLS protocols. Hemodynamically unstable patients received immediate pelvic binding and blood transfusion. External fixation or pelvic C-clamp was applied within the first 24 hours in unstable cases. Definitive surgical stabilization with ORIF was performed once patients were clinically stable. Data were analyzed for survival rates, complication incidence, and functional recovery over a 12-monthfollow-up.