Vol 10, No 3 (2003)

Articles
Tactics of Operative Treatment for Closed Long Bone Fractures in Patients with Polytrauma in Early Period
Sokolov V.A., Byalik E.I., Sokolov V.A., Byalik E.I.
Abstract
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 performed 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 performed 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.
N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(3):3-9
views
One-Stage Operation in Multiple and Concomitent Trauma
Litvina E.L., Skoroglyadov A.V., Gordienko D.I., Litvina E.A., Skoroglyadov A.V., Gordienko D.I.
Abstract
The question of the performance of one step operation in patients with concomitant and multiple trauma from the point of view of the choice of surgical intervention time, sequence and type of operation is considered. The advantages of one step operation include: one narcosis, one postoperative period, decrease of the risk of posttraumatic and postoperative complications, easing of treatment and nursing at intensive care unit as well as earlier rehabilitation. Criteria for the detection of the surgery time, sequence and type of operative intervention for individual patient with polytrauma were elaborated. Between 1998 and 2002, 282 one-step operations (71 emergency operations (within 5 hours after trauma), 135 urgent operations (within the first 3 days after trauma) and 76 delayed operations (within 10-14 days after trauma)) were performed at Moscow clinical Hospital #1 named after IV. I. Pirogov.
N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(3):10-15
views
Evaluation of Injury Severity: Review of the Most Commonly Used System for the Evaluation of Injury Severity in Traumatologic Patients
Karlbauer A., Woidke R., Karlbauer A., Woidke R.
Abstract
The most commonly used systems for the evaluation of injury severity in traumatologic patients are presented: Glasgo Coma Scale, Mangled Extremity Severity Score, Revised Trauma Score, Abbreviated Injury Scale, Injury Severity Score, Pediatric Trauma Score. Their advantages and disadvantages are given. At present Injury Severity Score is considered to be a «Golden Standard.
N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(3):16-19
views
Up-to-date Biological Dipped Osteosynthesis
Lazarev A.F., Solod E.I., Lazarev A.F., Solod E.I.
Abstract
Progressive direction in the development of inner osteosynthesis is the preservation of blood circulation in fracture zone, use of minimum operative approach and closed reposition. Authors have summarized the known principles of biological osteosynthesis and gave their opinion on problem. The experience in use of lightly invasive technique of osteosynthesis and AO implants are analyzed basing on 335 patients with fractures of various localization. Possibilities of active postoperative rehabilitation were shown. Original techniques of lightly invasive transcutaneous osteosynthesis with primary and secondary strained pins in periarticular fractures are given. Special attention is paid to the necessity of drug correction of bone quality in the postoperative period.
N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(3):20-26
views
System of Plates with Angular Stability (LCP) - the New AO Standard of Plate Osteosynthesis
Neubauer T., Wagner M., Hammerbauer C., Neubauer T., Wagner M., Hammerbauer C.
Abstract
Locking Compression Plate (LCP) represents the latest development of AO plates, combining the features of conventional plates and internal fixators. This is achieved by a so-called combi-hole merging the Dynamic Compression Unit (DCU) of the DCP and the threaded hole of locked plates. Therefore all kinds of conventional screws as well as threaded locking head screws (LHS) can be inserted through the plate depending on the specific local requirements. However, LCP represents not a new plate per se, but rather a plate/screw system to enrich the well known AO-plate designs with the option of interlocking. As the mechanical characteristics have not changed by adding a combi-hole the complete set of small (3,5 mm) and broad (4,5/5,0 mm) AO-plates is available. Additionally LCP-systems adapted to certain anatomic regions, like the proximal humerus and distal radius as well as Tomofix2 plates for osteotomies have been developed. We report about our first experience in clinical use of LCP. Prom April 2000 till December 2002, 310 LCP systems have been implanted in 274 patients. 303 plates (97,7%) were implanted for fixation of 285 fractures with different localization in 267 patients, including 17 pediatric fractures (5,9%), 9 periprosthetic fractures (3,2%), 5 delayed-unions (1,8%) and 4 pathologic fractures (1,4%). Seven plates (2,3%) were implanted to fix osteotomies. Of all plates 111 (35,8%) implants were fixed with locking head screws, 194 (62,6%) with both types of screws and only in 5 plates (1,6%) conventional screws were used. 73 (23,5%) of all plates were inserted using a minimal-invasive approach and 237 (76,5%) via an open procedure. Postoperative complications occurred in 14/267 patients (5,2%) exclusively treated for fractures, representing a complication rate of 5,2% in 15/285 fractures. Loosening of implants were seen in 1,4%), deep wound infection in 1,05%, osteomyelitis, refracture and postoperative hematoma in 0,7%, respectively. Secondary malalignment and problems with implant removal occurred in 1 patient (0,35%), respectively. No delayed or non-unions were observed. In LCP all options of plate osteosynthesis are included, so fixation can be adapted more accurately to the local situation and operative procedure is facilitated.
N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(3):27-35
views
Surgical Treatment of Distal Femur Fractures using LISS System
Cherkes-Zade D., Monesi M., Causero A., Marcolini M., Cherkes-Zade D., Monesi M., Causepo A., Marcolini M.
Abstract
Osteosynthesis with LISS system (less invasive stabilization system) is a new technology and this conception of stabilization of long bone fragments is a new step in the development of AO philosophy. Indications to application of this system are distal metaepiphysis and diaphysis femur fractures, supra- and transcondylar fractures in polytrauma, fractures in osteoporosis as well as fractures after total knee replacement. During the last 3 years 35 patients were operated on by that technique. The follow-up period ranged from 6 months to 3 years. Assessment of outcomes was performed using data of clinical examination and evaluation of radiograms with modified Neer-Grantham-Shelton scale. In patients who were operated on I year ago the total score varied from 70 to 80 (maximum - 100). Advantages of this technology as compared to the traditional methods of osteosynthesis are the following: limited operative trauma, less blood loss, shortening of surgery duration, preservation of tissue physiology as well as absence of the necessity to use cement and bone auto- and allografts. Disadvantages include the difficulty for reposition prior to fixation and impossibility of correction in postoperative period as well as early weight-bearing load.
N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(3):36-42
views
Surgery in Complex Treatment of Thoracic and Lumbar Spine Fractures
Ramikh E.A., Atamanenko M.T., Ramikh E.A., Atamanenko M.T.
Abstract
Between 1990 and 2001, 1540 patients with various fractures and fracture-dislocations of thoracolumbar vertebrae (type А, В, C) were operated on at the Regional Center for Spine Pathology of Novosibirsk RITO. Basing on that experience the indications and pathogenetic surgical techniques were defined for every clinical form of spine injury. Depending on the type of spine fracture and its stability the individual choice of technique for dorsal fixation, ventral spinal fusion or their combination provided the complete restoration of spine anatomy and stiff stabilization of the injured vertebral segments. Such differentiation in the treatment of various types of spine injuries permits to reduce the terms and stages of treatment thus predetermining favorable short-term and long-term outcomes.
N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(3):43-47
views
Surgical Treatment of Complicated Spine Injury in Acute Period
Aganesov A.G., Meskhi K.T., Nikolaev A.P., Kostiv E.P., Aganesov A.G., Meskhi K.T., Nikolaev A.P., Kostiv E.P.
Abstract
Analysis of surgical treatment of 193 patients with complicated injury of cervical, thoracic and lumbar spine was performed. Optimum time for surgery, approaches, operation stages as well as necessity of injured segments fixation are considered. In cervical spine injuries decompression, spondylodesis with autobone and CSLP (AO) plate fixation were performed. In thoracic and lumbar spine injuries decompressive laminectomy, revision, meningomyeloradiculosis when indicated, suturing of injured radicis with following transpedicular fixation using USS (AO) system were carried out. High efficacy of surgical treatment for complicated spine injuries is proved in availability of minimum time after injury, rational preoperative planning, adequate anesthesiology provision, wide decompression, and accurate choice of implanted metal device.
N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(3):48-52
views
Surgical Treatment in Comminuted Humerus Condyle Fractures of С Type by AO/ASIF Classification
Zhabin G.I., Shakhizi Fuad -., Fedyunina S.Y., Zhabin G.I., Shakhizi Fuad -., Fedyunina S.Y.
Abstract
Case reports of 61 patients with comminuted humerus condyle fractures were analyzed. In 58 patients the fractures were of С type by AO/ASIF classification. Basing on retrospective study of radiograms and surgical protocol the diagnosis was defined more precisely: in 72.2%o of cases the most severe fractures, i.e. of CI and C2 type, were determined. All patients were operated on. In 55 patients open reposition and osteosynthesis were carried out. In the majority of cases (68.9%) Y-shape plate was used for fixation. In 4 patients with CI and C2 fractures intraosseous osteosynthesis with rods was performed. In 4 other patients with C3 fractures osteosynthesis with bone autoplasty of the central area of condyle block was done. Two patients with the same type of fracture underwent total elbow replacement. In multicomminuted condyle fractures osteosynthesis with screws and pins as well as external immobilization for 3 weeks were performed. In the other cases the joint movements were started by 7-10 days after operation.
N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(3):53-56
views
Osteosynthesis for Fractures of Humerus Neck in Elderly Patients
Lazarev A.F., Solod E.I., Lazarev A.F., Solod E.I.
N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(3):57-61
views
Analysis of Functional Outcomes in Inner Osteosynthesis for Proximal Humerus Fractures
Lomtatidze E.S., Lomtatidze V.E., Potseluyko S.V., Toropov E.A., Lomtatidze E.S., Lomtatidze V.E., Posteluyko S.V., Toropov E.A.
Abstract
Between 1998 and 2002, 32 patients (11 males, 21 females), aged 26-78 years, with proximal humerus fractures were operated on. In 29 cases osseous osteosynthesis by AO technique with T- and L-shape plates and screws was performed, in 2 cases osteosynthesis was carried out using Kirshner wire and in 1 case with screws and wire. In all patients functional results were evaluated by American Shoulder and Elbow Surgeons system in terms from 7 to 48 months after operation. The following parameters were included: pain, movement range, muscular force, stability/instability of shoulder joint, limb function. In patients over 60 years movement range and limb function were reliably decreased compared to younger patients (p<0.05). Elderly age, osteopenia, complex nature of fractures negatively influenced the osteosynthesis outcomes. Tactics of surgical intervention in elderly patients should be based on the application of more sparing and stiff fixation.
N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(3):62-66
views
Restoration Treatment of Traumatic Dislocation of Clavicula Acromion End
Kotel'nikov G.P., Stukolov B.C., Chernov A.P., Kotel'nikov G.P., Stukolov V.S., Chernov A.P.
Abstract
On the base of clinical and radiologic examination of 143 patients with traumatic dislocation of clavicula acromion end a new classification was elaborated. Two groups of injuries were marked out: the first group - disturbances of ligaments without degenerative changes of the shoulder girdle structures; the second group - disturbances with degenerative dystrophic changes of shoulder girdle structures. Two new signs of clavicula dislocation were described: «symptom of crossed hands» and «key» late symptom. The complex of rehabilitation treatment included preoperative preparation, ligaments plasty, postoperative rehabilitation. Tifty-five patients with traumatic dislocation of clavicula acromion end were operated on using elaborated technique. Follow-up period ranged from 8 months to 3 years. Favorable results were achieved in 98.2% of patients.
N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(3):67-71
views
Diagnosis and Treatment of Marginal Acetabular Fractures
Ezhov Y.I., Smirnov A.A., Labazin A.L., Ezhov Y.L., Smirnov A.A., Labazin A.L.
Abstract
Experience in operative treatment of marginal acetabular fractures is presented. There were 47patients. Specific radiologic criteria determining the indications to osteosynthesis and choice of adequate approach to the hip joint were clarified. In 13 patients with old and comminuted fractures osteosynthesis was performed in combination with bone autoplasty. In 45 patients long-term results were observed in the period from 1 to 4 years. Despite the fact that most of patients (29) were operated on in the late terms (more than 2 weeks after trauma), 60% of patients had good and satisfactory outcomes.
N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(3):72-74
views
Treatment of Open Crus Fractures
Gordienko D.I., Skoroglyadov A.V., Litvina E.A., Mitish V.A., Gordienko D.I., Skoroglyadov A.V., Litvina E.A., Mitish V.A.
Abstract
Results of treatment of 112 patients were analyzed. All patients were treated at the Moscow Clinical Hospital named after N.l. Pirogov during the period from 1998 to 2002. Fifty-four patients had I and 11 type, 38 - IIIA, 14 - IIIB and 6 patients - IIIC type of fractures by Gustilo classification. Tactics of treatment was defined by patient's general condition and the degree of soft tissue injury. In fractures of I and II type primary UTN osteosynthesis was preferable; in fractures of IIIA type primary osteosynthesis with AO rod device or Piless device followed by final UTN osteosynthesis were performed. In fractures of IIIB type osteosynthesis was carried out using device. To all patients with fractures of IIIC type the limb amputation was performed. Healing by first intention took place in fractures of I and II type. In fractures of IIIA and IIIB type the open management of wound with following closure during sequential debridement was preferred. When tibia necrosis developed, the resection in fractures zone with following early defect substitution by IHzarov technique was carried out.
N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(3):75-78
views
Tactics for Complex Prevention and Treatment of Purulent-Septic Complications in Clinical Traumatology
Sergeev S.V., Ezmekna S., Zelenshna L.I., Novozhilova E.A., Golubeva V.L., Suvorova I.A., Yurina T.M., Zagorodniy N.V., Abdulkhabirov' M.A., Koshevarova' O.V., Sergeev S.V., Ezmekna S., Zelenkina L.I., Novozhilova E.A., Golubeva V.L., Suvorova I.A., Yurina T.M., Zagorodniy N.V., Abdulkhabirov M.A., Koshevarova O.V.
Abstract
The results of prevention and treatment of purulent and septic complications are presented. There were 21 patients with closed and open fractures and 21 patients with post-traumatic purulent complications and trauma sequelae. Thirteen patients had multiple and concomitant injuries. Treatment included the combination of surgical and conservative methods of fracture stabilization, antibiotic therapy as well as detoxication by efferent methods and immunocorrection.
N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(3):79-84
views
Limb Gunshot Wounds in Combination with Infectious Diseases (Mixes): Peculiarities of Diagnosis and Treatment
Nikolenko V.K., Akimkin V.G., Grivennikov V.P., Nikolenko V.K., Akimkin V.G., Gribennikov V.P.
N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(3):85-90
views
Tactics for Provision of Qualify Medical Care for Critically Burned. Prevention of Mistakes and Complications
Zhegalov V.A., Dmitriev D.G., Vorob'ev A.V., Vilkov S.A., Zhegalov V.A., Dmitriev G.G., Vorob'yev A.M., Vilkov S.A.
N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(3):91-97
views
G.I. Nazarenko
- -.
N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(3):98-98
views
L.A. Stakheev
- -.
N.N. Priorov Journal of Traumatology and Orthopedics. 2003;10(3):35-35
views

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies