Vol 4, No 2 (1997)

Protracted systemic disorders of homeostasis of traumatic disease may cause such severe and often lifeincompatible complications as acute respiratory and acute renal failure, sepsis, fat embolism. The effective way of their prevention is as early as possible rendering of qualified medical care to the injured. Under the Moscow First Aid Station there is a resuscitation-traumatologic CITO team. During 2,5 years the team rendered medical care to 1480 patients with severe multiorgan and concomitant injuries, 6,7% of patients had a severe degree of traumatic shock. Authors suggested the algorithms for diagnosis and prehospital management of severely injured. Use of those algorithms allowed to lower the rate of fat embolism and acute respiratory failure, to shorten the terms of assisted ventilation, duration of resuscitation and hospitalization. Twenty two patients (0,87%) with life incompatible injuries were lost.

On the basis of world literature data review and personal observations the authors conclude that primary osteosynthesis should be performed on the day of patient’s admission in case no special contraindications are present. The application of massive monolithic fixators is not expedient because of their depress the reparative regeneration in fracture zone and damage blood supply of the femoral head. Two fixators are sufficient for stable osteosynthesis: distal fixator is placed with support at Adams arch and/or Markel «spur» and prevents varus deformity of the femoral head and neck; proximal fixator is inserted into cortex of the femoral neck and prevents the backwards displacement. Stabilisation of femoral neck fragments with screws should be performed by their maximum insertion into cortical bone. Unipolar prosthesis of the femoral head or total hip replacement are indicated mainly in failed osteosynthesis.

The experience of surgical correction for combined injuries of pelvic bones and lower limbs was presented. There were 44 patients: 24 patients with acute trauma including 10 patients with injuries of the inner organs; and 20 patients with posttraumatic deformities and other sequela. Fractures of lower limbs (mainly femur and crus) were combined in 79.5% of cases with polyfocal injuries of pelvic ring and in 20.5% of cases with monofocal ones. Others’ technique of transosseous osteosynthesis for femur and crus fractures as well as closed reposition and pelvic ring stabilization was of relative simplicity and minimal trauma and allowed to perform lower limb fracrure osteosynthesis independently of the number of injured segments and fracrture number as well as to perform the operation by several teams simultaneously. Authors considered the following tactic as rational: 1) closed simultaneous reposition of pelvic ring and lower limb fractures may be performed on the day of patient’s admission; 2) delayed open surgical correction with combination of transosseous osteosynthesis may be performed simultaneously in the pelvic ring and lower limbs; 3) open surgical correction of pelvic ring and lower limbs may be performed separately and step-by-step.

The purpose of this study was to compare the treatment of open crus fractures with pin (116 patients) versus rod (107 patients) extrafocal fixation devices. In all cases primary osteosynthesis was performed within the first hours after trauma. Authors consider that choice of extrafocal fixation technique depends on the pattern of open fracture. Rod fixation is preferred in simple or wedge fractures. Pin fixation provides better outcome in all types of comminuted shaft fractures. Rod fixators are of more simple design than pin ones and it takes less time to handle with them. Uncomplicated postoperative period was noted in 179 patients (80.3%) out of 223. Purulent complications were in 16.5% of cases (5.8% of cases in rod fixation, 10.7% of cases in pin fixation). The rate of other complications was 3.2%.

Thirty three patients with open diaphysial fractures of II-III severity degree (according to Baylik’s classification) are presented. All patients were subjected to primary debridement, stable submersed or extrafocal osteosynthesis. Active combined drainage of fracture zone and soft tissue wound by the authors’ technique was included in the treatment. Application expediency of that method was grounded. Hemorheological examinations allowed to work out tactics of local and general use of rheological and inticoagulant medicines for the improvement of microcirculation in injured tissues. Authors’ complex of treatment gave the possibility to achieve good results in 87.7% of cases.

Authors observed 3 cases of heterotopic ossification that was a rare complication of the rupture of low limb muscles in top football-players Clinical manifestations, results of examinations were presented. Indications for operative treatment were defined. Peculiarities of surgical intervention and postoperative management were shown. After operative treatment all patients returned to their previous sports loads.

Based on results of experimental work and study of magneto therapy effect on healthy volunteers the clinical application of magneto therapy in traumatology and orthopaedics was elaborated. 3479 patients with various diseases of loco-motor system such as bone fractures, Legg-Calve- Perthes disease, humeroscapular periarteritis, humeral epicondylitis, tendovaginitis, Dupuytren’s contracture, keloid scars, tendo calcaneous bursitis, posttraumatic edema of extremities, radiculalgia, acute thrombophlebitis of lower limbs, obliterating endarteritis, arthroses and periartritis, etc., were treated by magneto therapy using devices both of author’s design and custom «Polus» as well as magnetoplates (firstly in clinical practice). Results of treatment testified high efficacy of magneto therapy and shoed the advantages of that safe and painless method as compared with other methods of treatment.

The problem of removing taiga ticks at first glance may seem unimportant. However, in the Far East, in Siberia, in the Urals, the bites of these insects remain a mass phenomenon. It is not always easy to remove a tick, and this explains the frequent visits of affected patients to a traumatologist.

Among the traumatogenic factors of various nature, a special place is occupied by a group of impulse dynamic effects caused by short-term high-energy effectors, the damaging effect of which is associated with the rapid transfer of a large amount of mechanical energy to tissues and organs. The development of experimental methods for determining the nature of energy distribution in individual anatomical and morphological structures and diagnosing the severity of the lesion is a very urgent problem that is of undoubted interest to a wide range of doctors, and especially traumatologists.

A.M. Borovikov, A.M. Ivanov, A.P. Kuzhekin, V.E. Kudryashov, A.V. Gnezdilov, A.S. Vitenzon, S.F. Kragin, B.G. Spivak (Central Institute of Prosthetics and Prosthetics): "TsNIIPP is a center for the medical rehabilitation of people with disabilities with lesions of the musculoskeletal system." The Central Research Institute of Prosthetics and Prosthetics is a scientific, medical and technical complex, the subject of which is the restoration or improvement of musculoskeletal functions and body shapes lost as a result of injuries, congenital, acquired diseases or age-related degeneration. The purpose of medical and technical rehabilitation is to improve the quality of life of people with disabilities without age restrictions. The Center combines modern neurophysiological, angiological, orthopedic-traumatological diagnostics, reconstructive orthopedic and plastic surgery with a wide use of microsurgical techniques, the use of physical methods of treatment, modern means of prosthetic and orthopedic and auxiliary equipment for the disabled within a single functional system. Long-standing traditions of restorative treatment and prosthetics, a good understanding of the specifics of the patient population, the absence of limits and restrictions in methods and terms are the advantages of the center.

60 years have passed since the birth of Gennady Alekseevich Onoprienko, Honored Scientist of the Russian Federation, Corresponding Member of the Russian Academy of Medical Sciences, full member of the International Academy of Informatization and the Academy of Medical and Technical Sciences of the Russian Federation, laureate of the Prize of the Government of the Russian Federation.