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Restorative treatment of victims with multiple gunshot fractures of long bones

Oleksandr Buryanov, Anatoliy Kazmirchuk, Yuriy Yarmolyuk, Myroslav Vakulych, Dmytro Drychyk

Abstract


Due to the large number of victims of the armed conflict in the east of Ukraine with multiple long-bones gunshot frac­tures, there was a need for comprehensive and step-by-step re­storative treatment at all levels of medical evacuation, espe­cially at III and IV.

Objective: to develop a step-by-step sys­tem for the rehabilitation of victims with multiple long-bone fractures and to prove its effectiveness in preventing the most common complications.

Methods: 380 patients were divided into three groups: the developed system and individual pro­grams of medical rehabilitation were used in the main (119 peo­ple), in I (118) — modern conventional methods of treatment, in II (143 wounded in Afghanistan) — methods, used in the 80th of the twentieth century, with effective rehabilitation. To as­sess the results of treatment, the Luboszyce-Mattisa-Schwarz­berg scale was chosen in the modification of Shevtsov.

Results: a rehabilitative treatment system was developed, including a reasoned replacement of the fixation method (biochemical and clinical blood tests, evaluation of the limb state), an al­gorithm for surgical treatment using modern medical tech­niques (VAC- therapy, ultrasound cavitation, Vivostat® PRF) and IDEP. The best long-term results (1.2–1.5 years) were ob­tained in patients of the main group compared with I and II. The risk of contamination of the operating wound in the patients of the main group decreased by 5.8 %, the occurrence of osteo­myelitis by 4.2 %, the incidence of neurologic deficits by 2.4 %, vascular disorders by 7.3 %, the development of false joints by 2.8 %, contractures — by 11.3 %.

Conclusions: the proposed system of restorative treatment of multiple long-bone fractures is effective in preventing the most common complications.

Keywords


multiple gunshot fractures of long bones; system of re¬storative fracture treatment; replacement of fixation method; individual program of medical rehabilitation

References


Ankin LN, Ankin NL. Delayed internal osteosynthesis in the treatment of gunshot fractures. Orthopaedics, Traumatology and Prosthetics. 2012;(2):114-8. doi: 10.15674/0030-598720122114-118. (in Russian)

Gayko GV. Intramedullary blocking osteosynthesis in the treatment of patients with closed fractures of long bones. Visnyk ortopedii, traumatologii i protezuvannya. 2007;(1):26-33. (in Russian)

Gayko GV, Kalashnikov AV, Malik VD. Treatment of patients with diaphyseal fractures of the tibia using blocking intramedullary osteosynthesis. Trauma. 2011;12(1): 6-8. (in Ukrainian)

Klimovitsky VG, Antonov AA, Grebenyuk AM. Rehabilitation in the early postoperative period with intramedullary blocked hip osteosynthesis. Trauma. 2009;10(1):9-13. (in Russian)

Korol SO, Bespalenko AA. Using modern methods of specialized traumatological treatment of injured with gunshot fractures of the long bones (IV level of health care). Litopys ortopedii ta travmatologii. 2015;1-2(31-32):28. (in Ukrainian)

Dazhin AY. Medical rehabilitation of patients with diaphyseal fractures of the forearm bones based on the surgical technologies. Medical Bulletin of Bashkortostan. 2012;2:157-161. (in Russian)

Cameron ID. Coordinated multidisciplinary rehabilitation after hip fracture. Disabil Rehabil. 2005;27(18–19):1081–90. doi: 10.1080/09638280500061261.

Tejan J, Lindsey RW. Management of civilian gunshot injuries of the femur. A review of the literature. Injury. 1998;29(1):SA18–22.

Brien WW, Kuschner SH, Brien EW, Wiss DA. The management of gunshot wounds to the femur. Orthop Clin North Am. 1995;26(1):133–8.




DOI: https://doi.org/10.15674/0030-59872017146-53

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Copyright (c) 2017 Oleksandr Buryanov, Anatoliy Kazmirchuk, Yuriy Yarmolyuk, Myroslav Vakulych, Dmytro Drychyk

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