COMPARATIVE EVALUATION OF TREATMENT OF KNEE JOINT FRACTURES IN PATIENTS WITH POLYTRAUMA
About the author:
Mamedov A. Sh.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
The knee joint is the most frequently injured joint, accounting for up to 50% of all joint injuries and up to 24% of lower limb injuries. This kind of damage, especially in victims with polytrauma, often lead to loss of supporting and motor functions of the injured limb. Purpose. Improving the results of treatment of patients with knee fractures in polytrauma through the use of modern diagnostic techniques and the development of new surgical treatments. Method of research. The results of treatment of 224 patients with intraarticular fractures of tibial and femoral condyles with displacement of fragments were studied. Of these, 65 victims were treated in 2000-2005, they were treated with conservative methods (49 cases), or performed osteosynthesis, used in those years methods – spokes and Ilizarov apparatus (16 cases). These victims formed a control group of the study. Among them 24 (37%) had isolated character of damage, and 41 (63%) the victim – multiple and combined. The second group of the study is the victims with fractures of the tibial and femoral condyles with displacement, who were on treatment in the period 2006-2018. 10 (6%) of them were treated conservatively due to certain circumstances. Surgical treatment was performed in 149 (94%) patients of this group and it was carried out using diagnostic and modern therapeutic methods. These victims were the main group – 159 people. 57 (36%) of them had isolated nature of damage, and 102 (64%) had multiple and combined. All the victims of the mechanism of injury were divided into 4 groups: auto injury, cataract, industrial and other (falling in the home from a height of growth). Dominant damage to the musculoskeletal system in polytrauma was found in 83 (58%) victims, the skull and chest, respectively, in 15 and 14%. In 32 patients (22.5%) of the main group, osteosynthesis was performed urgently, in 107 (71.8%) – in delayed, and 8 patients (5.4%) were operated on as planned. To the category of urgent surgical interventions we refer osteosynthesis during the primary reactions of the body to injury, that is, in the first 48 hours. Delayed – this intervention in the first two weeks after the injury. Planned two weeks after the injury. From the number surveyed in a state of shock delivered in the clinic 143 patients (63%) of all admitted for fractures of the condyles. To diagnose damage to the musculoskeletal system, radiography was performed in two standard projections when the victims arrived. According to the indications, depending on the accompanying injuries, other instrumentalmethods of research were used: laparocentesis, thoracocentesis, thoracoscopy, laparoscopy, electrocardiography, echoencephalography and computed tomography. Results. To assess the results of treatment of patients in the control and the main groups were compared, the study groups are fairly homogeneous in different General and local characteristics of their indicators. Therefore, to evaluate the proposed approaches and methods of treatment of damage to the knee joint in polytrauma, a comparison of the nearest and remote anatomical and functional results in patients of both groups was carried out. Only 8.6% of patients with polytrauma in the control group achieved good immediate results, while in the main group this figure is 49% (P0,05). The main reasons for the unsatisfactory immediate result are primarily a conservative method of treatment, in which more often have to resort to long-term immobilization of the limb. Conclusion. In patients with polytrauma, the presence of intraarticular fracture of the knee joint is almost an absolute indication for the surgical method of treatment. At the same time, it can be applied taking into account objective criteria of admissibility in various periods of traumatic disease, both urgently and in a delayed or planned manner and the technical possibility of intervention is provided, it must be performed urgently, that is, in the first 48 hours. The use of conservative methods in this category of victims leads to unsatisfactory results of treatment.
fractura of the condilus, multiply trauma, head-scull injury
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 2 Part 2 (151), 2019 year, 136-139 pages, index UDK 617.582.5-089