Traumatology chair Traumatology chair and orthopedy of and orthopedy of

ВОЕННО-ВОЕННО-ПОЛЕВОЙ surgery ПОЛЕВОЙ surgery

Chief of the chair Chief of the chair Doctor of medical sciences Doctor of medical sciences

Karimov Мurod Karimov Мurod UldashevichUldashevich

PolyinjuryPolyinjury

In traumatology departments of city In traumatology departments of city permanent establishment of sick permanent establishment of sick with polyinjury meet at 15-30% sick, with polyinjury meet at 15-30% sick, when catastrophes this figure when catastrophes this figure achieves 40% and more.achieves 40% and more.

The term <the polyinjury> is The term <the polyinjury> is collective concept, including inter se collective concept, including inter se following the kinds of damages: following the kinds of damages:

Multiple, combined, combined.Multiple, combined, combined.

Multiple, combined and combined Multiple, combined and combined the injuries are different by the the injuries are different by the distinctive gravity clinical symptoms, distinctive gravity clinical symptoms, accompanied with great disorder of accompanied with great disorder of vital bodily functions, diagnostics vital bodily functions, diagnostics difficulty, treatment complexity, high difficulty, treatment complexity, high процентностью and disablement, процентностью and disablement, high lethality.high lethality.

Of its kind damage much more often Of its kind damage much more often is followed by the traumatic shock, is followed by the traumatic shock, bloodloss, posing a threat to bloodloss, posing a threat to impairments of circulation and impairments of circulation and respiration.respiration.

Combined call damage, received in Combined call damage, received in effect of different traumatic factors: effect of different traumatic factors: mechanic, thermal, radiation.mechanic, thermal, radiation.

Monofocal is single trauma it is only Monofocal is single trauma it is only in one site of аnatom-function of in one site of аnatom-function of education: fracture of external education: fracture of external ankle, diaphysis fracture of thigh-ankle, diaphysis fracture of thigh-bone on a level, rupture of the bone on a level, rupture of the medial meniscus.medial meniscus.

Polifokal - damage in several places Polifokal - damage in several places of one анатомо-функционального of of one анатомо-функционального of education: diaphysis of thigh-bone education: diaphysis of thigh-bone on two levels, rupture of the medial on two levels, rupture of the medial meniscus together with rupture of meniscus together with rupture of the lateral ligament knee joint.the lateral ligament knee joint.

PolifocalPolifocal Hip fractureHip fracture

To multiple mechanical trauma To multiple mechanical trauma belong damage two or more internal belong damage two or more internal organs in one cavity (for example the organs in one cavity (for example the livers and intestines ), two and more livers and intestines ), two and more анатомо-функциональных анатомо-функциональных educations of опорно-двигательной educations of опорно-двигательной system (for example the hip fracture system (for example the hip fracture and forearm ).and forearm ).

Combined damages consider the Combined damages consider the simultaneous damage of internal simultaneous damage of internal organs in two and more cavities (for organs in two and more cavities (for example the lung damage and spleen example the lung damage and spleen ) or the damage of internal organs ) or the damage of internal organs and segment of опорно-and segment of опорно-двигательной system (for example двигательной system (for example mild brain injury and the fracture of mild brain injury and the fracture of bones of extremities ).bones of extremities ).

The injury two anatomical regions The injury two anatomical regions met at 50% injured, met at 50% injured,

Three - at 30%, four and more - at Three - at 30%, four and more - at 20%. 001 three20%. 001 three

Thromboembolism. Thromboembolism. When damages of one anatomical When damages of one anatomical

region 40, 6% tomical region 40, 6%region 40, 6% tomical region 40, 6% Four and more 79% Four and more 79% Purulent complications Purulent complications 2, 5-3 time more often, than when 2, 5-3 time more often, than when

single injuries.single injuries.

LethalityLethality

When damages of one anatomical region When damages of one anatomical region 9, 8% 9, 8%

Two body regions 26, 3% ions 26, 3%Two body regions 26, 3% ions 26, 3% Three 41, 5% Three 41, 5%Three 41, 5% Three 41, 5% Four 63, 2% Four 63, 2%Four 63, 2% Four 63, 2% Пяти 77, 8% Пяти 77, 8%Пяти 77, 8% Пяти 77, 8%

Treatment of multiple and combined fractures of Treatment of multiple and combined fractures of bones of extremities in the acute period of injury bones of extremities in the acute period of injury was subjected to decision three of basic tasks. was subjected to decision three of basic tasks.

Reestablishment of vital function affected when Reestablishment of vital function affected when injury. injury.

2. Prevention and treatment of manifold 2. Prevention and treatment of manifold complications, conditioned by the traumopathy. complications, conditioned by the traumopathy.

3. Maximally early mobilization of sick to allow 3. Maximally early mobilization of sick to allow for recovery of activity of all bodies and systems, for recovery of activity of all bodies and systems, including and motion system.including and motion system.

Urgent - the reanimation operations, aimed at Urgent - the reanimation operations, aimed at saving the lives, which must be executed by saving the lives, which must be executed by regardless of severity of the state (the regardless of severity of the state (the laparotomy, aimed at stoppage of laparotomy, aimed at stoppage of intraabdominal bleeding and so on ). intraabdominal bleeding and so on ).

Primary - the life-saving operations, which Primary - the life-saving operations, which

shall be effected after conducting of shall be effected after conducting of reanimation and antishock actions (the injury reanimation and antishock actions (the injury of spinal cord, cranial trepanation, wound пхо of spinal cord, cranial trepanation, wound пхо and the osteosynthesis compound fracture of and the osteosynthesis compound fracture of crus, the hip osteosynthesis ).crus, the hip osteosynthesis ).

Отстроченный the osteosynthesis - is produced Отстроченный the osteosynthesis - is produced more often in the period of complete stabilization of more often in the period of complete stabilization of condition, as a rule on 7-8 the day after the trauma condition, as a rule on 7-8 the day after the trauma (the fracture posterior margin of вертлужной basin (the fracture posterior margin of вертлужной basin when posterior dislocation of the femur ). when posterior dislocation of the femur ).

Therapy principle of polyinjury: Therapy principle of polyinjury: 0 quick examination 0 quick examination 0 full-fledged therapy 0 full-fledged therapy 0 early operation0 early operation

Indications to preliminary treatment of Indications to preliminary treatment of fracture is: fracture is:

0 heavy shock and terminal state 0 heavy shock and terminal state 0 mass receipt of sick 0 mass receipt of sick 0 possibility absence to fulfil definitive 0 possibility absence to fulfil definitive

expert care of fractures. expert care of fractures. The basic task of doctor to distinguish The basic task of doctor to distinguish

dominant the injury. dominant the injury. For example hip fracture and rupture of the For example hip fracture and rupture of the

liver.liver.

Thank you for Thank you for Attention and angelic patience!Attention and angelic patience!