2 Городская клиническая больница им. А.К. Ерамишанцева, Москва, РФ; 3 ФГБУ «Национальный медицинский исследовательский центр травматологии и ортопедии им. Н.Н. Приорова» Минздрава России, Москва, РФ; 4 ГБУЗ КО «Калужская областная клиническая больница скорой медицинской помощи им. К.Н. Шевченко», Калуга, Россия Цель исследования: представить первый опыт использования способа фиксации переломов лонных костей с помощью спиц с нарезкой и возможности его применения в практике.
Аbctract. Treatment of long bones fractures of the extremities has a particular relevance in modern traumatology due to their high frequency, as well as a large number of deaths in patients with polytrauma. It is dangerous to perform an urgent final osteosynthesis in severe patients because of the possibility of shock and the deterioration of the condition of the injured. Therefore, the principle of Damage control with urgent fixation of damaged segments by external fixation and their subsequent replacement (converse) to intramedullary osteosynthesis had a particular relevance in the treatment of patients with long bones fractures. Purpose: Improving treatment outcomes for patients with long bones fractures. Materials and methods. In the present study, a retrospective analysis of using conversion osteosynthesis in the treatment of 120 patients with long bones extremities fractures in a multidisciplinary hospital was carried out. For a better analysis of the results of treatment, we divided the patients into two groups: The first group 44 patients with fractures of the long bones with polytrauma according to the ISS severity scale> 17. The second group consists of 76 patients with closed isolated unstable comminuted fractures of the long bones with severe post-traumatic edema, who have a high risk of significant trauma of soft tissues. Results. The most optimal time for conversion osteosynthesis to patients with polytrauma was 7-12 days, which prevented the occurrence of traumatic shock; and for patients with closed isolated unstable fractures of long bones with significant of post-traumatic edema for conversion osteosynthesis, the optimal time was 3-7 days after injury, which prevented the occurrence of inflammatory complications in the postoperative period. Conclusion. The study confirmed the feasibility of conversion osteosynthesis in the treatment of patients with diaphyseal fractures. The use of the technique of transferring the fixation of fragments by the external fixation device to the internal osteosynthesis (conversion) contributed to a reduction in the duration of inpatient treatment of patients with fractures of the long bones.
Purpose of study: determine the optimal approach to the treatment of patients with pelvic fractures against a background of low bone mass. Patients and methods. During the period from 2017 to 2018, 64 patients were treated (average age 78±7.4 years) with fragility pelvic ring injuries. Fractures according to AO/OTA classification A2 - 5 (7.8%), B1 - 18 (28.1%), B2 - 28 (43.7%), B3 - 8 (12.5%), C1 - 3 (4.6%), C2 - 2 (3.1%). Long-term results were evaluated after 6 and 12 months, according to the Majeed scale and the «Timed up & go» test. Results. Intrahospital mortality was 7 (10.9%) people. The annual mortality rate was 31.2%. Results after a year were monitored in 44 patients. Good results in 40 patients, 3 satisfactory, 1 poor result. The previous level of activity was restored by 30 (68.1%) of 44 patients. Conclusion. The treatment of elderly patients with pelvic fractures on the background of osteoporosis should be multidisciplinary with the appointment of postoperative rehabilitation in specialized hospitals, comprehensive treatment of osteoporosis and therapist’s supervision to compensate for premorbid background. The decision on the final fixation of the pelvis should take into account the nature of the fracture, the degree of its stability, the level of patient activity before and after the injury, the degree of compensation of the general condition, the severity of osteoporosis.
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