Опубликовать статью

Информационное партнерство

Инфоресурсы

Контакты

«

Vol. 12, Art. 53 (pp. 631-645)    |    2011       

»

Treatment of long-bone fractures in polytraumatized patients

V.V.Khominets, I.G.Belenkiy, D.I.Kutyanov, Pechkurov A.L.

Brief summary

We have analyzed the Russian and foreign works dealing with the problem of treatment of long-bone fractures in polytraumatized patients. We have carefully studied various aspects of the problem of choice of optimal tactics of treatment of such patients. The majority of specialists agree that early total care (ETC) is justified in case of stable and borderline patients with ISS < 25. It includes also the definitive fixation of bony fragments with the use of the internal minimal invasive ostheosynthesis. In other cases the use of damage control orthopedics (DCO) is optimal. Yet we cannot say that the problem of choice of the optimal tactics of treatment long-bone fractures in case of severe polytrauma has been solved by nowadays. The main difficulties occur not in the nearest but in the early and tardive posttraumatic period. It is caused by the lack of strict criteria for determing the opportunity of operating extremities. Working out the criteria determing the optimal terms of use of the external devices as the initiate osteosynthesis, opportunity of performing the initiate internal osteosynthesis and the consistent use of the internal fixation in the early posttraumatic period should be considered the main direction of the further scientific research.


Key words

polytraumatized patients, long-bone fractures, early total care, damage control orthopedics, posttraumatic disorders, external osteosynthesis, internal osteosynthesis

Reference list

1.Faddeev, D.I. Rannii metalloosteosintez zakritih i otkritih mnojestvennih i sochetannih perelomov dlinnih trybchatih kostei / D.I.Faddeev. - Smolensk, 1997. - 364 s.


2.Qi, X. Statistical analysis on 2213 in-patients with traffic injuries from January 2003 to September 2005 in Ningbo city / X.Qi [et al.] // Chin. J. Traumatol. – 2006. - Vol. 9. – R. 228-233.


3.Enweluzo, G.O. Pattern of extremity injuries in polytrauma in Lagos, Nigeria / G.O.Enweluzo [et al.] // Niger Postgrad Med J. – 2008. –Vol. 15. – P. 6-9.


4.Agadjanyan, V.V. Lechenie bolnih s politravmami za poslednie 10 let / V.V.Agadjanyan // Politravma. - 2006. - № 3. – S. 5 – 8.


5.Sokolov, V.A. Mnojestvennie i sochetannie travmi / V.A.Sokolov – M.: «GEOTAR- Media», 2006. - 483 s.


6.Bondarenko, A.V. Organizaciya specializirovannoi pomoshi pri politravme v krypnom gorode / A.V.Bondarenko // Vestnik travmatologii i ortopedii im. N.N.Priorova - 2005. - № 4. – S. 81 – 84.


7.Agadjanyan, V.V. Politravma: perspektivi issledovaniya problemi / V.V.Agadjanyan // Politravma. - 2007. - № 3. – S. 5 – 7.


8.Sannikova, E.V. Epidemiologiya travm i pyti povisheniya kachestva i effektivnosti lecheniya postradavshih / E.V.Sannikova: Dis. … kand. med. nayk. - SPb., 1999. – 158 s.


9.Kovtyn, V.V. Lechenie sochetannih povrejdenii vnytrennih organov i otkritih perelomov konechnostei / V.V.Kovtyn, G.M.Kravjyl // V sezd travmatologov-ortopedov SSSR: Tez. dokl. – Ch. 1. – M., 1988. – S. 101.


10. Faddeev, D.I. Rannii metalloosteosintez otkritih perelomov dlinnih kostei pri politravme / D.I.Faddeev // Problemi politravmi. Lechenie mnojestvennih i sochetannih povrejdenii i perelomov: Mater. konf. – Smolensk, 1998. - S. 98 – 99.


11. Bondarenko, A.V. Gospitalnaya letalnost pri sochetannoi travme i vozmojnosti ee snijeniya / A.V.Bondarenko [i dr.] // Vestnik travmatologii i ortopedii im. N.N.Priorova - 2004. - № 3. – S. 49 – 52.


12. Sokolov, V.A. Sindrom vzaimnogo otyagosheniya povrejdenii y postradavshih s sochetannoi travmoi / V.A.Sokolov [i dr.] // Vestnik hiryrgii im I.I.Grekova - 2006. – T. 165, № 4. – S. 25 – 29.


13. Pasternak, V.N. Stryktyra invalidnosti postradavshih s mnojestvennimi i izolirovannimi perelomami dlinnih kostei konechnostei / V.N.Pasternak [i dr.] // Travma. – 2002. - T. 3, № 1. – S. 40-43.


14. Pirojkova, T.A. Analiz pervichnoi invalidnosti sredi bolnih s posledstviyami travm oporno-dvigatelnoi sistemi v gorode Moskve za period 1999-2003 godov / Pirojkova T.A. // Zdorove stolici: Mater. 4 moskovskoi assamblei - M., 2005. - S. 47.


15. Schmidt-Rohlfing, B. Scoring systems for outcome after knee injuries / B.Schmidt- Rohlfing [et al.] // Injury. – 2011. – Vol. 42. – P. 271-275.


16. Ivanov, P.A. Lechenie otkritih perelomov dlinnih kostei konechnostei y postradavshih s mnojestvennoi i sochetannoi travmoi: dis. …d-ra med. nayk / P.A.Ivanov. – M., 2009. – 370 s.


17. Byalik, E.I. Osobennosti lecheniya otkritih perelomov dlinnih kostei y postradavshih s politravmoi / E.I. Byalik [i dr.] // Vestnik travmatologii i ortopedii im. N.N.Priorova - 2002. - № 4. – S. 3 – 8.


18. Sokolov, V.A. Osnovnie osobennosti sochetannih travm na etapah stacionarnogo lecheniya / V.A.Sokolov [i dr.] // Okazanie pomoshi pri sochetannoi travme: Sb. naych. trydov - Yaroslavl, 1997. - S. 103-109.


19. Scalea, T.M. External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fractures: damage control orthopedics / T.M.Scalea [et al.] // J Trauma – 2000. – Vol. 48, № 4. – R. 613-623.


20. Nicholas, B. Borderline femur fracture patients: early total care or damage control orthopaedics? / B.Nicholas [et al.] // ANZ J Surg. – 2011. – Vol. 81. – P. 148-153.


21. Glymcher, F.S. Optimalnoe vremya operacii na kostyah skeleta y bolnih s politravmoi / F.S.Glymcher [i dr.] // Travma. – 2003. - T. 4, № 2. – S. 189-192.


22. Hildebrand, F. Damage control: extremities / F.Hildebrand [et al.] // Injury - 2004. - Vol. 35. – R. 678-689.


23. Sokolov, V.A. «Damage control» - sovremennaya koncepciya lecheniya postradavshih s kriticheskoi politravmoi / Sokolov V.A. // Vestnik travmatologii i ortopedii im. N.N.Priorova - 2005. - № 1. - S. 81-84.


24. Roberts, C.S. Damage control orthopaedics. Evolving concepts in the treatment of patients who have sustained orthopaedic trauma / C.S.Roberts [et al.] // J Bone Joint Surg. – 2005. – Vol. 87-a, № 2. – P. 434-449.


25. Renaldo, N. Damage-control orthopedics: evolution and practical applications / N.Renaldo, K.Egol // Am J Orthop. – 2006. – Vol. 35, № 6. – R. 285-291.


26. Skoroglyadov, A.V. Lechenie dvystoronnih (simmetrichnih) diafizarnih perelomov bedra / A.V.Skoroglyadov [i dr.] // Vestnik Rossiiskogo gosydarstvennogo medicinskogo yniversiteta - 2003. - № 5. – S. 44 – 47.


27. Nast-Kolb, D. Management of polytrauma / D.Nast-Kolb [et al.] / Chirurg. – 2006. – Vol. 77, № 9. – R. 861-873.


28. Scannell, B.P. Skeletal traction versus external fixation in the initial temporization of femoral shaft fractures in severely injured patients / B.P.Scannell [et al.] // J. Trauma. – 2010. – Vol. 68. – P. 633-640.


29. Zito, E.S. Mainly abdominal «complex» polytrauma. Considerations on surgical strategy and clinical case report // E.S.Zito [et al.] // Ann. Ital. Chir. – 2006. – Vol. 77, N 1. - P. 33 - 38.


30. Ratner, G.L. Travmaticheskii shok v biologicheskom aspekte / G.L.Ratner //Vestnik hiryrgii im. I.I.Grekova - 1988. - № 1. - S. 113-115.


31. Pronskih, A.A. Taktika lecheniya povrejdenii oporno-dvigatelnoi sistemi y bolnih s politravmoi – Politravma. - 2006. - № 1. – S. 43 – 47.


32. Litvina, E.A. Odnoetapnie operacii pri mnojestvennoi i sochetannoi travme / E.A.Litvina [i dr.] // Vestnik travmatologii i ortopedii im. N.N.Priorova - 2003. - № 3. – S. 10 – 15.


33. Shmidt, I.Z. Opit lecheniya politravmi v reanimacionnom otdelenii travmatologicheskoi kliniki / I.Z.Shmidt [i dr.] // Vestnik Rossiiskogo gos. med. yn-ta - 2003. - № 5. – S. 6 – 10.


34. Higgins, T.F. Damage control nailing / T.F.Higgins, D.S.Horwitz // J. Orthop. Trauma. – 2007. – Vol. 21. – P. 477-481.


35. Voronkevich, I.A. Hiryrgicheskoe lechenie mnojestvennih i sochetannih s cherepno-mozgovoi travmoi diafizarnih perelomov dlinnih trybchatih kostei / I.A.Voronkevich: Dis. … kand. med. nayk - SPb., 1998. – 179 s.


36. Agadjanyan, V.V. Politravma: problemi i prakticheskie voprosi – Politravma. - 2006. - № 1. – S. 5 – 8.


37. Grinev, M.V. Hiryrgicheskaya taktika pri shokogennih mnojestvennih i sochetannih travmah oporno-dvigatelnogo apparata / M.V.Grinev, G.M.Frolov // Vestnik travmatologii i ortopedii im. N.N.Priorova - 1994. - № 1. – S. 4 – 9.


38. Baker, S.P. The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care / S.P.Baker [et al.] // J Trauma – 1974. – Vol. 14. – R. 187- 196.


39. Balogh, Z. NISS predicts postinjury multiple organ failure better than the ISS / Z.Balogh [et al.] // J Trauma – 2000. – Vol. 48. – R. 624-628.


40. Knaus, W.A. APACHE II: A severity of disease classification system / W.A.Knaus [et al.] // Critical Care Medicine, 1985. - Vol. 13, № 10. - R. 818-829.


41. Boyd, C.R. Evaluating Trauma Care: The TRISS Method / C.R.Boyd [et al.] // J Trauma – 1987. – Vol. 27. – R. 370-378.


42. Champion, H.R. Improved predictions from a severity characterization of trauma (ASCOT) over Trauma and Injury Severity Score (TRISS): results of an independent evaluation / H.R.Champion [et al.] // J Trauma – 1996. – Vol. 40. – R. 42-49.


43. Karlbauer, A. Ocenka tyajesti travmi: obzor naibolee chasto ispolzyemih sistem dlya ocenki tyajesti povrejdenii y travmatologicheskih bolnih / A.Karlbauer, R.Woidke // Vestnik travmatologii i ortopedii im. N.N.Priorova - 2003. - № 3. – S. 16 – 19.


44. Gymanenko, E.K. Kompleksnaya ocenka tyajesti travm. Metod. rekomendacii / E.K.Gymanenko // M., 1993. – 32 s.


45. Gymanenko, E.K. Sochetannie travmi s pozicii obektivnoi ocenki tyajesti travm / E.K.Gymanenko: Avtoref. dis. … d-ra med. nayk. – SPb, 1992. – 50 s.


46. Samohvalov, I.M. Erozii i yazvi verhnih otdelov jelydochno-kishechnogo trakta y postradavshih s tyajeloi sochetannoi travmoi / I.M.Samohvalov [i dr.] // Voen.-med. jyrn. - 2009. - № 3. - S. 30-34.


47. Krettek, C. Hannover Fracture Scale’98 – re-evaluation and new perspectives of an established extremity salvage score / C.Krettek [et al.] // Injury. – 2001. - Vol. 32. – R. 317-328.


48. Helfet, D.L. Limb salvage versus amputation: preliminary results of the Mangled Extremity Severity Score / D.L.Helfet [et al.] // Clin Orthop. – 1990. – R. 80-86.


49. McNamara, M.G. Severe open fractures of the lower extremity: a retrospective evaluation of the Mangled Extremity Severity Score (MESS) / M.G.McNamara [et al.] // J Orthop Trauma – 1994. - Vol. 8. – R. 81-87.


50. Seekamp, A. Parameters of multiple organ dysfunction fail to predict secondary amputation after limb salvage in multiple traumatised patients / A.Seekamp [et al.] // Injury – 1999. - Vol. 30. – R. 199–207.


51. Yokoyama, K. New scoring system predicting the occurrence of deep infection in open upper and lower extremity fractures: efficacy in retrospective re-scoring / K.Yokoyama [et al.] // Arch. Orthop. Trauma. Surg. – 2009. – Vol. 129. – P. 469-474.


52. Abakymov, M.M. Obektivnaya ocenka tyajesti travmi y postradavshih s sochetannimi povrejdeniyami / M.M.Abakymov [i dr.] // Vestnik hiryrgii im I.I.Grekova - 2001. – T. 160, № 6. – S. 42 – 45.


53. Kyzmichev, A.P. Lechenie postradavshih s sochetannoi cherepno-mozgovoi travmoi na etapah medicinskoi evakyacii: Metod. rekomendacii / A.P.Kyzmichev [i dr.]. – M., 1981. – 25 s.


54. Syvalyan, A.G. Hiryrgicheskaya taktika pri sochetannoi travme cherepa i nijnih konechnostei / A.G.Syvalyan [i dr.] // Vestnik travmatologii i ortopedii im. N.N.Priorova - 1999. - № 3. – S. 11 – 16.


55. Lyadova, M.V. Lechenie vnytrisystavnih i okolosystavnih perelomov dlinnih kostei y bolnih s sochetannoi cherepno-mozgovoi travmoi / M.V.Lyadova, [i dr.] // Vestnik Rossiiskogo gos. med. yn-ta - 2003. - № 5. – S. 10 – 15.


56. Plahotnikov, B.A. Hiryrgicheskaya taktika lecheniya perelomov dlinnih trybchatih kostei pri sochetannih travmah: dis. …kand. med. nayk / B.A.Plahotnikov. - SPb, 2001.- 188 s.


57. Giannoudis, P. When should we operate on major fractures in patients with severe head injuries? / P.Giannoudis [et al.] // Am. J. Surg. - 2002. –Vol. 183. - P. 261-267.


58. Arpacioglu, M.O. Treatment of femoral shaft fractures by interlocking in-tramedullary nailing in adults / M.O.Arpacioglu [et al.] // Acta Orthop. Traumatol. – 2003. – Vol. 37, № 3. R. 203-212.


59. White, T.O. The early response to major trauma and intramedullary nailing / T.O.White [et al.] // J Bone Joint Surg Br. – 2006. – Vol. 88, № 6. – P. 823-827.


60. Bhandari, M. Operative management of lower extremity fractures in patients with head injuries / M.Bhandari [et al.] // Clin Orthop. – 2003. – Vol. 407. – R. 187-198.


61. Grotz, M.R.W. Traumatic brain injury and stabilisation of long bone fractures: an update / M.R.W.Grotz [et al.] // - Injury. – 2004. - Vol. 35. – R. 1077-1086.


62. Byalik, E.I. Rannii osteosintez perelomov kostei konechnostei pri sochetannoi travme / E.I.Byalik: Dis. … d-ra med. nayk. - M., 2004. – 338 s.


63. Brundage, S. Timing of femur fracture fixation: effect on outcome in patients with thoracic and head injuries / S.Brundage [et al.] // J. Trauma. - 2002. – Vol. 52. - R. 299-307.


64. Carash, W. Delayed surgical fixation of femur fractures is a risk factor for pulmonary failure independent of thoracic trauma / W.Carash [et al.] // J. Trauma – 1994. – Vol. 37, № 4. - P. 667-672.


65. Hausmann, B. Risk of fat embolism syndrome after intramedullary nailing in femoral fracture and thoracic injury / B.Hausmann, K.Hudabiunigg // Unfallchirurgie – 1994. – Vol. 20, № 3. – R. 162-168.


66. Pape, H.C. Impact of the method of initial stabilization for femoral shaft fractures in patients with multiple injuries at risk for complications (borderline patients) / H.C.Pape [et al.] // Ann. Surg. – 2007. – Vol. 246, № 3. - R. 491-501.


67. Anwar, L.A. Femur fractures and lung complications: a prospective randomized study of reaming / L.A.Anwar [et al.] // Clin. Orthop. and Relat. Res. - 2004. - № 422. – R. 71-76.


68. Bone, L.B. Treatment of femoral fractures in the multiply injured patient with thoracic injury / L.B.Bone [et al.] // Clin Orthop. – 1998. – Vol. 347. – R. 57-61.


69. Aufmkolk, M. Effect of primary femoral plate osteosynthesis on the course of polytrauma patients with or without thoracic trauma / M.Aufmkolk [et al.] // Unfallchirurg. - 1998. - Vol. 101, № 6. - P. 433-439.


70. Streubel, P.N. Comparison of RIA and conventional reamed nailing for treatment of femur shaft fractures / P.N.Streubel [et al.] // Injury. – 2010. – Vol. 41, Suppl. 2. – P. 51-56.


71. Weninger, P. Early unreamed intramedullary nailing of femoral fractures is safe in patients with severe thoracic trauma / P.Weninger [et al.] // J Trauma – 2007. – Vol. 62, № 3. – R. 692-696.


72. Wild, M. Treatment strategies for intramedullary nailing of femoral shaft fractures / M.Wild [et al.] // Orthopedics – 2010. – Vol. 33, № 10. – R. 726.


73. Deryabin, I.I. Travmaticheskaya bolezn / I.I.Deryabin, O.S.Nasonkin // L.: Medicina, 1987. - 304 s.


74. Gymanenko, E.K. Kliniko-patogeneticheskoe obosnovanie vidov i srokov osteosinteza dlinnih kostei pri sochetannih travmah / E.K.Gymanenko [i dr.] // Patogenez i lechenie sochetannih travm. - L., 1989. - S. 24-25.


75. Eruhin, I.A. Ekstremalnie sostoyaniya organizma / I.A.Eruhin, S.A.Shlyapnikov // SPb, 1997. - 288 s.


76. Travmaticheskaya bolezn i ee oslojneniya / S.A.Seleznev [i dr.] (red.) // SPb.: Politehnika, 2004. - 414 s.


77. Maier, M. Operative secondary interventions during the intensive care of the polytrauma – what may and what has to he operated? / M.Maier [et al.] // Springer Medizin Verlag, 2007. – Online publiziert. – 31 May 2007.