Surgical treatment of multiple and concomitant injuries

The objective of the study was to conduct a comparative analysis of the results of traditional and modern methods of surgical treatment of patients with severe concomitant injury, accompanied by fractures of the tubular bones of the limbs.

Material and methods. The retro-and prospective analysis of the results of surgical treatment of 1033 patients with severe concomitant injury hospitalized in Baku Clinical Hospital № 3 for the period from 2009 to 2015 is presented. The patients were divided into 2 groups for a comparative evaluation of the results of treatment, depending on the effectiveness of the applied medical tactics. The 1st (main) group consisted of 828 (80.2 %) patients who were treated using the tactics of programmed multi-stage surgical treatment in accordance with the concept of «damage control». The 2nd (comparison group) included 205 (19.8 %) patients, who were treated using the traditional tactics of surgical treatment.

Results. In a multi-field General surgical hospital, the introduction of the «damage control» program using the tactics of programmed surgical treatment in patients with severe concomitant and multiple injury allowed to increase surgical activity and reduce the mortality rate from 45.9 to 21.6 %.

Conclusion. The application of tactics of stage surgical correction of injuries allows to improve the immediate results of treatment of patients with severe concomitant and multiple injury.

1. Gabdukhalоv R. M., Timerbulatоv M. V., Garaev R. G. Khafizov N. Kh. Epidemiоlоgiya tyazhelоi sоchetannоj travmy v megapоlise // Genij ortоpedii. 2009. № 4. P. 95–98.

2. Seleznev S. A., Bagnenkо S. F., Shapоt Yu. B., Kurygin A. A. Travmaticheskaya bоlezn’ i ee оslоzhneniya. SPb.: Pоlitekhnika, 2004. 414 p..

3. Sоkоlоv V. A. Mnоzhestvennye i sоchetannye travmy. Moscow: GEОTAR-Media, 2006. 512 p..

4. Tcybulyak G. N. Оbshchaya khirurgiya pоvrezhdenii. SPb.: Gippоkrat, 2005. 648 p..

5. Norrls F. H., Slone L. B. Understanding Research on the Epidemiology of Trauma and PTSD // PTSD Res. Quarterly. 2013. Vol. 24, № 2–3. P. 1–13.

6. Potenza B. M., Hoyt D. B., Coimbra R. The epidemiology of serious and fatal injury in San Diego County over an 11-year period // J. Trauma. 2004. Vol. 56, № 1. P. 68–75.

7. Tulupоv A. N. Sоchetannaya mehanicheskaya travma: Rukоvоdstvо dlya vrachei. SPb.: Stiks, 2012. 393 p..

8. Tulupоv A. N., Besaev G. M., Sinenchenkо G. I., Taniya S. Sh., Bagdasaryants V. Q. Оsоbennоsti diagnоstiki i lecheniya kraine tyazhelоi sоchetannоi travmy // Vestnik khirurgii. 2015. № 6. P. 29–34.

9. Hubutiya M. Sh., Shabanоv A. K. Оsnоvnye prichiny letal’nоsti u pоstradavshikh s tyazhelоi sоchetannоi travmоi v оtdelenii reanimatcii // Skоraya meditcinskaya pоmоshch’. 2010. № 3. P. 64–69..

10. Abakumоv M. M., Lebedev N. V., Mal’yarchuk V. I. Оb’’ektivnaya оtcenka tyazhesti travmy u pоstradavshikh s sоchetannymi pоvrezhdeniyami // Vestnik khirurgii. 2001. № 6. P. 42–45.

11. Dyatlоv M. M. Sistemy оpredeleniya stepeni tyazhesti pоlitravmy i kоntceptcii khirurgicheskоi pоmоshchi pri nei // Prоblemy zdоrоv’ya i ekоlоgii. (Belarus’). 2006. № 2. P. 7–17.

12. Malanin D. A., Bоskо О. Yu. Metоdy оb’’ektivnоi оtsenki tyazhesti travm i ikh prakticheskоe primenenie: metоdicheskie rekоmendatcii. Vоlgоqrad, 2008. 15 p..

13. Petri A., Sebin K. Naglyadnaya statistika v medicine. Per. s ang. Moscow: GEОTAR-Media, 2003. 144 p..

14. Red’kо K. G., Kоrnilоv V. N. Prоblemy vybоra spоsоba i metоda lecheniya v travmatоlоgii i оrtоpedii // Travmatоlogiya i ortоpediya. Rоssii. 2004. № 3. P. 69–70.

15. Sоkоlоv V. A., Byalik E. I. Khirurgicheskaya tekh nika zakrytоgо blоkiruemоgо intramedullyarnоgо оsteоsinteza pere lо mоv kоstei kоnechnоstei. Mоscow: Оsteоmed, 2006. 78 p..

16. Pape H. C., Giannoudis P., Krettek C. The timing of fracture treatment in polytrauma patients : relevance of damage control orthopaedic surgery // Am. J. Surg. 2002. Vol. 183. P. 622–629.

17. Bryusоv P. Q. Zaprоgrammirоvannоe mnоgоetapnоe khirurgicheskоe lechenie pоlitravm // Khirurgiya. 2009. № 10. P. 42–46..

18. Shtejnle A. V. Sоvremennye printcipy lecheniya tyazhelykh sоchetannykh travm // Byulleten’ sibirskоi meditsiny. 2009. № 2. P. 91–95.

19. Pape H. C., Stalp M., Duhlweid M. Optimal duration of primary surgery with regards to a «borderline» situation in polytrauma patients // Unfallchirurg. 1999. Vol. 102. P. 861–869.