Strategies of Osteosynthesis: Problems and Perspectives
- Authors: Belen'kiy I.G.1,2, Manukovskii V.A.1,3, Tulupov A.N.1, Demko A.E.1, Kandyba D.V.1, Sergeev G.D.1,2, Maiorov B.A.2, Barsukova I.M.1,4, Adzhimuradov B.O.1
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Affiliations:
- St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine
- St. Petersburg State University
- Mechnikov North-Western State Medical University
- Pavlov First Saint Petersburg State Medical University
- Issue: Vol 28, No 2 (2022)
- Pages: 79-90
- Section: Discussions
- URL: https://journal-vniispk.ru/2311-2905/article/view/124882
- DOI: https://doi.org/10.17816/2311-2905-1693
- ID: 124882
Cite item
Abstract
Background. Urgent osteosynthesis requires number of organizational, material, technical and staff resources.
Aim of the study — to determine advantages and disadvantages of existing strategies for osteosynthesis basing on literature data and comparative analysis of organization of osteosynthesis on the first day after injury and at a later time.
Methods. Data were collected through review of medical records from first half of 2021 calendar year and consist of the patients have been treated by different types of osteosynthesis on the first day after admission to the hospital and later. Average length of hospital stay (LOS) for surgical procedures and duration of the operative time were compared.
Results. In total 266 osteosynthesis of the extremities immediately after admission to the hospital were performed in the first half of 2021 in 260 patients. The most frequently performed ankle fractures fixation (20.7%) and clavicle fractures surgical repairment (13.9%). Cases of early infections complications and no revision surgeries required due to unstable fixation after urgent osteosynthesis were excluded. In the same period 659 delayed osteosynthesis were performed. Mean value of inpatient day in patients, who underwent urgent surgery, was 8.40±16.67 days, while patients, who underwent delayed surgery, spent significantly greater (p<0.05) amount of time in the hospital — 12.98±6.28 days in average.
Discussion. Three strategies of osteosynthesis exist: urgent surgeries, delayed surgeries in daytime in operating rooms for planned surgeries and combination of these approaches. Urgent osteosynthesis surgeries do not lead to infectious complications or unstable fixation, what makes them viable option while choosing treatment tactics in case of some injuries. Precise determination of patient groups according to fracture pattern and its localization, that can be operated on in urgent manner, is necessary. Moreover, introduction of urgent osteosynthesis requires serious organizational measures. It is also necessary to perform economical assessment of described approach. Only after solving these questions, it will be possible to make final conclusions about optimal strategy for performing osteosynthesis.
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##article.viewOnOriginalSite##About the authors
Igor’ G. Belen'kiy
St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine; St. Petersburg State University
Author for correspondence.
Email: belenkiy.trauma@mail.ru
ORCID iD: 0000-0001-9951-5183
SPIN-code: 6594-8334
ResearcherId: V-5248-2019
Dr. Sci. (Med.)
Russian Federation, 3, Budapeshtskaya str., St. Petersburg, 192242; St. PetersburgVadim A. Manukovskii
St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine; Mechnikov North-Western State Medical University
Email: sekr@emergency.spb.ru
ORCID iD: 0000-0003-0319-814X
Dr. Sci. (Med.), Professor
Russian Federation, 3, Budapeshtskaya str., St. Petersburg, 192242; St. PetersburgAleksandr N. Tulupov
St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine
Email: altul@yandex.ru
ORCID iD: 0000-0003-2696-4847
Dr. Sci. (Med.), Professor
Russian Federation, 3, Budapeshtskaya str., St. Petersburg, 192242Andrei E. Demko
St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine
Email: demkoandrey@gmail.com
ORCID iD: 0000-0002-5606-288X
Dr. Sci. (Med.), Professor
Russian Federation, 3, Budapeshtskaya str., St. Petersburg, 192242Dmitrii V. Kandyba
St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine
Email: kandyba@emergency.spb.ru
ORCID iD: 0000-0002-9715-5505
Cand. Sci. (Med.)
Russian Federation, 3, Budapeshtskaya str., St. Petersburg, 192242Gennadii D. Sergeev
St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine; St. Petersburg State University
Email: gdsergeev@gmail.com
ORCID iD: 0000-0002-8898-503X
Russian Federation, 3, Budapeshtskaya str., St. Petersburg, 192242; St. Petersburg
Boris A. Maiorov
St. Petersburg State University
Email: bmayorov@mail.ru
ORCID iD: 0000-0003-1559-1571
Cand. Sci. (Med.)
Russian Federation, St. PetersburgIrina M. Barsukova
St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine; Pavlov First Saint Petersburg State Medical University
Email: bim-64@mail.ru
ORCID iD: 0000-0002-5398-714X
Dr. Sci. (Med.), Assistant Professor
Russian Federation, 3, Budapeshtskaya str., St. Petersburg, 192242; St. PetersburgBagautdin O. Adzhimuradov
St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine
Email: badzhimuradov@mail.ru
ORCID iD: 0000-0001-7931-3111
Russian Federation, 3, Budapeshtskaya str., St. Petersburg, 192242
References
- Беленький И.Г., Кутянов Д.И., Спесивцев А.Ю. Структура переломов длинных костей конечностей у пострадавших, поступающих для хирургического лечения в городской многопрофильный стационар. Вестник Санкт-Петербургского университета. Медицина. 2013;(1):134-139. Belenkiy I.G., Kutyanov D.I., Spesivtsev A.Yu. [Long-bone fractures in patients who need surgical treatment in municipal multi-field emergency hospital]. Vestnik Sankt-Peterburgskogo universiteta. Meditsina [Vestnik of Saint Petersburg University. Medicine]. 2013;(1): 134-139. (In Russian).
- Тихилов Р.М., Воронцова Т.Н., Беленький И.Г. Вопросы стандартизации специализированной медицинской помощи пострадавшим с переломами костей голени в условиях городского многопрофильного стационара. Травматология и ортопедия России. 2013;2(68):5-12. Tikhilov R.M., Vorontsova T.N., Belenkiy I.G. [Standardization of spedalized medical care to patients with shin fractures in multifield city hospital]. Travmatologiya i ortopediya Rossii [Traumatology and orthopedics of Russia]. 2013;2(68):5-12. (In Russian).
- Frink M., Lechler P., Debus F., Ruchholtz S. Multiple Trauma and Emergency Room Management. Dtsch Arztebl Int. 2017;114(29-30):497-503. doi: 10.3238/arztebl.2017.0497.
- Koivukangas V., Saarela A., Meriläinen S., Wiik H. How Well Planned Urgency Class Come True in The Emergency Surgery? Timing of Acute Care Surgery. Scand J Surg. 2020;109(2):85-88. doi: 10.1177/1457496919826716.
- FitzPatrick M.K., Reilly P.M., Laborde A., Braslow B., Pryor J.P., Blount A. et al. Maintaining patient throughput on an evolving trauma/emergency surgery service. J Trauma. 2006;60(3):481-486; discussion 486-488. doi: 10.1097/01.ta.0000205861.29400.d9.
- Leppäniemi A., Jousela I. A traffic-light coding system to organize emergency surgery across surgical disciplines. Br J Surg. 2014;101(1):e134-e140. doi: 10.1002/bjs.9325.
- Caesar U., Karlsson J., Hansson E. Incidence and root causes of delays in emergency orthopaedic procedures: a single-centre experience of 36,017 consecutive cases over seven years. Patient Saf Surg. 2018;12:2. doi: 10.1186/s13037-018-0149-1.
- van der Wee M.J.L., van der Wilden G., Hoencamp R. Acute Care Surgery Models Worldwide: A Systematic Review. World J Surg. 2020;44(8):2622-2637. doi: 10.1007/s00268-020-05536-9.
- Кейер А.Н., Фролов Г.М., Савельев М.С., Кашанский Ю.Б. Хирургическая тактика при тяжелой травме, основанная на объективных критериях тяжести состояния пострадавших. Вестник хирургии им. И.И. Грекова. 1982;(7):86-90. Keier A.N., Frolov G.M., Savel’ev M.S., Kashanskii Yu.B. [Surgical tactics in severe trauma, based on objective criteria for the severity of the condition of the victims]. Vestnik khirurgii im. I.I. Grekova [Grekov’s Bulletin of Surgery]. 1982;(7):86-90. (In Russian).
- Ax M., Reito A., Koskimaa M., Uutela A., Paloneva J. Scheduled Emergency Trauma Operation: The Green Line Orthopedic Trauma Surgery Process Of Care. Scand J Surg. 2019;108(3):250-257. doi: 10.1177/1457496918803015.
- Ono Y., Ishida T., Iwasaki Y., Kawakami Y., Inokuchi R., Tase C. et al. The off-hour effect on trauma patients requiring subspecialty intervention at a community hospital in Japan: a retrospective cohort study. Scand J Trauma Resusc Emerg Med. 2015;23:20. doi: 10.1186/s13049-015-0095-1.
- Landrigan C.P., Rothschild J.M., Cronin J.W., Kaushal R., Burdick E., Katz J.T. et al. Effect of reducing interns’ work hours on serious medical errors in intensive care units. N Engl J Med. 2004;351(18):1838-1848. doi: 10.1056/NEJMoa041406.
- Arnedt J.T., Owens J., Crouch M., Stahl J., Carskadon M.A. Neurobehavioral performance of residents after heavy night call vs after alcohol ingestion. JAMA. 2005;294(9):1025-1033. doi: 10.1001/jama.294.9.1025.
- Bhattacharyya T., Vrahas M.S., Morrison S.M., Kim E., Wiklund R.A., Smith R.M. et al. The value of the dedicated orthopaedic trauma operating room. J Trauma. 2006;60(6):1336-1340; discussion 1340-1341. doi: 10.1097/01.ta.0000220428.91423.78.
- Crist B.D., Ferguson T., Murtha Y.M., Lee M.A. Surgical timing of treating injured extremities. J Bone Joint Surg Am. 2012;94(16):1514-1524. doi: 10.2106/JBJS.L.00414.
- Goslings J.C., Ponsen K.J., Luitse J.S., Jurkovich G.J. Trauma surgery in the era of nonoperative management: the Dutch model. J Trauma. 2006;61(1):111-114; discussion 115. doi: 10.1097/01.ta.0000222704.86560.ac.
- Goh Y.M., Vitish-Sharma P., Saad A., Bibi S., Talving P., Ponchietti L. The Future of Emergency Surgery. Chirurgia (Bucur). 2017;112(5):566-572. doi: 10.21614/chirurgia.112.5.566.
- al-Ayoubi F., Eriksson H., Myrelid P., Wallon C., Andersson P. Distribution of emergency operations and trauma in a Swedish hospital: need for reorganisation of acute surgical care? Scand J Trauma Resusc Emerg Med. 2012;20:66. doi: 10.1186/1757-7241-20-66.
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