Minimally Invasive Osteosynthesis in Patients with Severe Combined Trauma and Polytrauma

Introduction. Treatment of patients with combined trauma and polytrauma is one of the most difficult issues in traumatology characterized by high mortality, long-term disability and high level of disability. In recent decades, there has been an increase in combined injuries in Russia, primarily associated with an increased number of road accidents (crashes) - up to 53.19 %, - and industrial injuries - about 23.4% of cases. Apparently, this trend will only increase in the coming decades.
Such injuries are accompanied by formation of traumatic foci, which are the trigger mechanism of pathologies such as traumatic diseases, multiple organ dysfunction and multiple organ failure. Even when it is possible to bring the patient out of shock and avoid multiple organ failure – a multi-month period of delayed convalescence or a period of trophic disorders of traumatic disease often results in the disability of the rescued patient. These circumstances, on the one hand, force surgeons to choose an active, more” aggressive" tactic for osteosynthesis to early activate a patient; on the other hand, - to search for less "aggressive" methods of osteosynthesis. In recent years, new, specially designed minimally invasive systems for surgical treatment of fractures have been developed in Russia; this being the reason for the revision of traditional osteosynthesis expanding the possibility of active surgical tactics in patients with severe combined trauma and polytrauma.
The aim of the study was to improve clinical outcomes of patients with severe combined trauma and polytrauma, to develop a model of early trauma care.
Materials and methods. The study included clinical findings of 636 patients with severe combined trauma and polytrauma, 223 patients in the control group, and 413 patients in the main group. Long-term anatomical and functional and labor outcomes, the quality of life from 3 to 5 years after injury were studied. Immediate results of treatment were studied in all 497 patients, long-term results in 414. The effectiveness of fracture treatment was evaluated according to the Neer-Grantham-Shelton scale, which is based on a score of 5 clinical and 1 X-ray signs. During the study, the developed intraosseous, bone fixators and methods of osteosynthesis were applied.
Results. The study demonstrated that the proposed tactics for treating patients with severe combined trauma and polytrauma, which included the application of new methods and devices developed for minimally invasive osteosynthesis, resulted in the improved clinical outcomes: an increased number of positive outcomes by 14.2%, a decreased number of satisfactory outcomes by 10.24%, and unsatisfactory outcomes by 4.02 %.
Conclusions. Thus, high operational activity in the acute period of traumatic disease based on the objective criteria for the severity of the patient's condition and prognosis of shock is a must in the treatment of patients with severe combined trauma and polytrauma. The time, volume and method of operational assistance depend on the patient’s condition, which prognostic group the patient is included, the result of dynamic prognosis. Early fixation of injuries performed by minimally-traumatic methods (with external fixators), closed intramedullary osteosynthesis with locking screws contributes to the prevention of complications of early and subsequent periods of traumatic illness.