Analysis of surgical treatment of tibial fractures fractures during the antiterrorist operation

Authors

  • Sergii Korol

DOI:

https://doi.org/10.15674/0030-59872016210-14

Keywords:

medical therapies, medical care levels, gunshot tibial fractures, mine-explosive injury, severed limbs

Abstract

Objective: To analyze the surgical procedures performed at all levels of medical care in the wounded with gunshot fractures of the tibia and severed limbs during the anti-terrorist operation (ATO).

Methods:it is analyzed medical care in 118 wounded (May 2014–April 2015) with tibial gunshot fractures in 111 (94.07 %) and severed limbs — 7 (5.93 %).

Results: in the wounded with tibial gunshot fractures and severed limbs temporary bleeding control, aseptic bandage application, pain management transport immobilization with improvised means provided at the primary and I medical care levels with following evacuation to the II level of the medical care. Beginning from the II level, all wounded underwent primary surgical treatment (PST). Osteosynthesis with external fixation device (EFD) performed in 76.27 % patients, revision surgical treatment (ST) — in 72.03 %, fasciotomy — in 23.73 %, free autodermoplasty — in 15.25 %, Ilizarov device osteosynthesis — in 15.25 %, amputation — in 10.17 %, nailing — in 8.47 %, plating — in 5.93 %, autogenous prosthesisng — in 5.08 %, VAC therapy — in 4.24 %, revision surgical treatment — 3.38 %. At the II level of medical care PST, final bleeding control, fasciotomy and stable fixation with external fixation device performed mainly. At the III and IV levels revision ST with VAC-therapy and ultrasound cavitation executed. After the soft tissue healing with the inflammation signs absence in 14.40 % patients external fixation device changed to the plate or nail. After 6–12 month good functional results obtained in 54.31 % of patients, satisfactory — in 30,17 %, unsatisfactory — in 15.52 %. Organizational, treatment and diagnostic mistakes were analyzed.

References

  1. Ankin NL, Ankin LN. Trauma. European standards diagnosis and treatment. Book Plus, 2012. 463 c.
  2. Brizhan LK. System of treat the wounded with gunshot fractures of the long bones of the limbs (clinical experimental research): abstract dis. the doctor of medical science, 2010. 52 p.
  3. Zarutsky YL, Shudrak AA. Instructions military surgery, 2014. 396 p.
  4. Gumanenko EK, Samohvalov IM. Military surgery local wars and armed conflicts, 2011. 672 p.
  5. Lysenko MV, Nikolenko VK, Brizhan LK. Military surgery: Manual for practical training. GEOTAR Media, 2010. 571 p.
  6. Emergency surgery military. Nash Format, 2015. 365 p.
  7. Shapovalov VM. New in the theory and practice of treatment the injured limb. Vestnik traumatologii i ortopedii im. NN Priorova. 2010;4:18–22.
  8. Bykov IY, Efimenko NA, Gumanenko EK. Military surgery: national guidance. GEOTAR Media, 2009. 720 p.
  9. Atef A, El-Tantawy А. Management of open infected comminuted tibial fractures using Ilizarov concept. Eur J Orthop Surg Traumatol. 2014;24(3):403–408. doi: 10.1007/s00590-013-1204-3.
  10. Azzam W, Atef А. Our experience in the management of segmental bone defects caused by gunshots. Int Orthop. 2016.40(2):233–238. doi: 10.1007/ s00264-015-2870-z.
  11. Girard PJ, Kuhn KM, Bailey JR, Lynott JA, Mazurek MT. Bone transport combined with locking bridge plate fixation for the treatment of tibial segmental defects: a report of 2 cases. J Orthop Trauma. 2013;27(9):220–226. doi: 10.1097/ BOT.0b013e31827069b9.
  12. Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma. 1984;24(8):742–746.
  13. Konda SR, Davidovitch RI, Egol KA. Open knee joint injuries an evidence-based approach to management. Bull Hosp Jt Dis. 2014;72(1):61–69.
  14. Seng VS, Masquelet AC. Management of civilian ballistic fractures. Orthop Traumatol Surg Res. 2013;99(8):953–958. doi: 10.1016/j.otsr.2013.08.005.
  15. Konda SR, Howard D, Davidovitch RI, Egol KA. The role of computed tomography in the assessment of open periarticular fractures associated with deep knee wounds. J Orthop Trauma. 2013;27(9):509–514. doi: 10.1097/BOT.0b013e31828b7001.

How to Cite

Korol, S. (2016). Analysis of surgical treatment of tibial fractures fractures during the antiterrorist operation. ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS, (2), 10–14. https://doi.org/10.15674/0030-59872016210-14

Issue

Section

ORIGINAL ARTICLES