Tactics of surgical treatment of closed fractures of long bones of the extremities in patients with polytrauma in the early period

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Results of the treatment of 218 victims with polytrauma were analyzed during the period from 1998 to 2202. There were 127 patients with one and 91 patients with several closed fractures. Authors consider osteosynthesis for closed long bone fractures to be an urgent operation of third term. Osteosynthesis is absolutely indicated to the patients with psychomotor excitation, in cases of the threat for skin perforation by bone fragments and in patients requiring intensive nursing for their life rescue. The choice of operative method depends on polytrauma severity and fracture type. When osteosynthesis is petformed by urgent indications in patients with polytrauma the requirements to osteosynthesis stiffness are higher than in isolate injuries, as the rotation displacement, migration and fixator deformity frequently take place in unconscious patients who need constant intensive nursing. In patients with concomitant thorax injury urgent intramedullar osteosynthesis by nail is contraindicated due to the possibility of fat embolism syndrome development. In these patients plate osteosynthesis is preferred. If there are no absolute indications to urgent osteosynthesis this operation could be petformed on 3—10 days after trauma using lightly traumatic and invasive methods not waiting for the complete normalization of homeostasis parameters and restoration of soft tissues in the fracture zone. In closed long bone fractures tactics of early osteosynthesis allows to decrease the rate of hypostatic complications and mortality by more than 10% and achieve good functional results.

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V. Sokolov

Research Institute of Emergency Medicine. N.V. Sklifosovsky

Email: info@eco-vector.com
俄罗斯联邦, Moscow

E. Byalik

Research Institute of Emergency Medicine. N.V. Sklifosovsky

编辑信件的主要联系方式.
Email: info@eco-vector.com
俄罗斯联邦, Moscow

参考

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2. Fig. 1. Radiographs of patient A. Comminuted femoral fracture type B. a — before surgery; b — after osteosynthesis with a pin and an additional plate.

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3. Fig. 2. Radiographs of patient L. Comminuted fracture of the right femur (a — on admission, b — after closed osteosynthesis with blocking); fracture of the left femur (c — on admission, d — after closed osteosynthesis with blocking); comminuted fracture of the bones of the left leg (e — on admission, f — after closed osteosynthesis with blocking). Fig. 1. Fig. 2. Radiographs of patient L. Comminuted fracture of the right femur (a — on admission, b — after closed osteosynthesis with blocking); fracture of the left femur (c — on admission, d — after closed osteosynthesis with blocking); comminuted fracture of the bones of the left leg (e — on admission, f — after closed osteosynthesis with blocking).

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