MANAGEMENT OF PATIENTS WITH PATHOLOGICAL FRACTURES IN THE REPUBLIC OF MOLDOVA

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Fracturile patologice reprezintă o problemă importantă de sănătate publică în Republica Moldova (RM), survenite ca urmare a osteoporozei, metastazelor canceroase sau boala Paget. Managementul pacienților cu fractură patologică în RM implică un proces complex de evaluare, tratament și îngrijire. Scopul lucrării. Evaluarea practicilor naționale de management clinic al pacienților cu fracturi patologice pentru racordarea acestora la practicile internaționale. Rezultate. Evaluarea clinică minuțioasă și imagistică adecvată este primordiala în abordarea clinică a acestor pacienți. În baza datelor obținute (gradul de fractură și stadiul afecțiunii subiacente) se trasează planul de tratament. Abordarea clinică este una multidisciplinară, care implică ortopezi, oncologi, radiologi, fiziokinetoterapeuți și alte cadre medicale specializate. Tratamentul propus poate fi conservator sau chirurgical, incluzând: proceduri minim invazive - vertebroplastia și cimentoplastia și osteosinteza. Alegerea procedurii depinde de localizarea și gradul fracturii, starea generală a pacientului și afecțiunea preexistentă care a condiționat fractura. Conduita post-terapică a pacienților cu fractura patologică implică un program intensiv de reabilitare, cuprinzând terapie fizică, kinetoterapie și alte forme de terapie adjuvantă pentru a asigura restabilirea funcției și a mobilității. Suportul psihologic și școlarizarea pacienților sunt indispensabile pentru prevenția fracturile. Concluzii. Managementul pacienților cu fractură patologică în RM presupune o abordare multidisciplinară și calitativă prin evaluarea riguroasă, tratamentul adecvat și îngrijirile post-tratament care asigura recuperarea rapidă și sigură a pacienților. Dezvoltarea tehnologiilor și asigurarea cu resurse necesare pentru formarea personalului competent este obligatorie.Introduction. Pathological fractures represent an important public health problem in the Republic of Moldova (RM), occurring as a result of osteoporosis, cancer metastases or Paget’s disease. Management of patients with pathological fracture in MR involves a complex process of assessment, treatment and care. Objective of the study. Evaluation of national practices of clinical management of patients with pathological fractures for their connection to international practices. Results. Thorough clinical evaluation and appropriate imaging are paramount in the clinical management of these patients. Based on the obtained data (degree of fracture and stage of the underlying condition) the treatment plan is drawn up. The clinical approach is multidisciplinary, involving orthopedists, oncologists, radiologists, physiotherapists and other specialized medical personnel. The proposed treatment can be conservative or surgical, including: minimally invasive procedures - vertebroplasty and cementoplasty and osteosynthesis. The choice of procedure depends on the location and degree of the fracture, the general condition of the patient and the pre-existing condition that caused the fracture. The post-therapeutic management of patients with pathologic fracture involves an intensive rehabilitation program, including physical therapy, physical therapy, and other forms of adjunctive therapy to ensure the restoration of function and mobility. Psychological support and patient education are indispensable for fracture prevention. Conclusions. The management of patients with pathological fracture in MR requires a multidisciplinary and qualitative approach through rigorous evaluation, appropriate treatment and post-treatment care that ensures rapid and safe recovery of patients. The development of technologies and the provision of necessary resources for the training of competent personnel is mandatory

Calcaneus fractures

Department of Orthopedics and Traumatology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young DoctorsIntroduction. Calcaneus fractures are the result of high energy trauma, falls from height, road accidents. Calcaneus fracture constitutes 60% of the Tarsian fractures, 75% of them are intraarticular and represent 2% of the total fractures, more commonly happens with men between 21-45 years (90%). Aim of the study. The study of contemporary literature with reference to the treatment of calcaneus fractures with the purpose to assess the treatment strategy. Materials and methods. There were 28 literary sources, articles and scientific papers studied. Results. Signs of calcaneus fractures are: deformation of the calcaneous region accompanied by its widening transversely, deletion of the malleolar reliefs and of the Ahilian tendon, flattening of the plantar arch and the "numeral" ecchymosis in the plantar area, mobility in the ankle joint is diminished. The degree of movement of the fragments depends on the kinetic energy of the trauma. The evaluation of a calcaneus fracture begins with radiography in 2 projections, anterior-posterior, with the calculation of the Bohler and Gissan angle and the axial projection (Harris). Bohler classification (usually 20-40) is a criterion for assessing the severity of the fracture. The gold standard in the diagnosis of calcaneus fractures is the computed tomography using the Sanders classification and in case of lack of CT examination the Broden projections are made. Treatment depends on the anatomical-clinical form of the fracture. Orthopedic treatment is indicated for fractures without displacement, as well as for the thalamic (Sanders I) and for the extratalamic ones. Graffin type gypsum immobilization is done if the soft tissues allow. f not, the foot will be put in a prone position with the mobilization of the fingers and ankle joint from the first days. Percutaneous osteosynthesis with cannulated screws is indicated for extratalamic fractures. Surgery is indicated for thalamic fractures Sanders IIIIV - open reduction and osteosynthesis with plate and screws. The optimum time for surgery is in the first 3 weeks and when the "Wrinkle" test is positive. The outcome of the surgical treatment as well as the orthopedic treatment is influenced by the factors related to the patient (diabetes, peripheral vascular disease, obesity, smoking, the elderly, late addressing, serious injuries associated) as well as the path of the fracture. Conclusions. Patients with calcaneus fracture treated surgically have a shorter rehabilitation period compared to those treated orthopedic. The functional result is better when the Bohler angle and the anatomical reduction is restored