Osteosynthesis methods in polytrauma with musculoskeletal system injuries

Orthopedics and Traumatology Clinic ”Vitalie Bețișor”, State University of Medicine and Pharmacy ”Nicolae Testemițanu”, Republic of Moldova, Al VIII-lea Congres Naţional de Ortopedie și Traumatologie cu participare internaţională 12-14 octombrie 2016Purpose: to analyze osteosynthesis methods in polytrauma and their performing time. Material and methods: were analyzed methods and early results of surgical treatment in polytrauma patients treated in IEM, in period 2011-2015. Polytrauma were classified according to 4 regions in: cvadriregional – 2(2,6%), triregional – 19(24,7%), biregional – 56(72,7%). The study group was – 77 patients surgically treated, including 29(37,7%) women and 48(62,7%) men. Average age was 37.5 years, predominantly affecting working-age population (21-60 years) - 68 (88.3%), with highest incidence in group 18-30 years - 31(40.2%). Musculoskeletal lesions were: 140 fractures, multiple - 53(68.8%) and single - 24(31.2%); open fractures-13(9.3%) cases. Fractures in upper limb and scapular-humeral belt were 56(40%), pelvis-21(15%), lower limb - 57(40.7%) and spine - 6(4.3%) cases. Results: immediate surgery - 13(16,9%) cases of open fractures, chosen osteosynthesis material being external fixator. Delayed surgical treatment - 64(83,1%) cases, performed at 1-19 days after trauma, with an average of 6.5 days. Osteosynthesis methods consisted of: intramedullary nail – 29(37,6%), DCS – 2(2,6%), plate and screws – 26(33,7%), modular plate – 7(9,1%), angular stable plate – 1(1,3%), transkeletal traction – 5(6,5%), PFN – 2(2,6%), supporting plate – 4(5,2%), K-wire – 13(16,8%), screws – 4(5,2%). The immediate results were appreciated by X-ray aspect, being satisfactory in all cases. Conclusions: Surgical treatment of MS injuries is divided into serial operations, respecting the order of priority of injuries depending on their vital risk (Damage Control Orthopaedics) and simultaneous surgeries performed along with deshock supported therapy (Early Total Care), which tend to settle early and definitively maximum of lesions in polytrauma. Duration and volume of surgical interventions for skeletal injuries in polytrauma should be chosen with consideration of injuries severity, patient’s state and traumatic disease period

Intra focal osteosynthesis for distal radial fractures in emergency – Kapandji method

Institute of Emergency Medicine, Chișinău, Republic of Moldova, Municipal Hospital of Bălți, Republic of Moldova, Al VIII-lea Congres Naţional de Ortopedie și Traumatologie cu participare internaţională 12-14 octombrie 2016Aim: to present the results of surgical treatment using Kapandji method in emergency. Material and methods: were analyzed the results of surgical treatment in patients with distal radius fractures treated in IEM during 2013-2015. Fractures were classified using Kapandji A. (1988) classification. Emergency surgical treatment was applied in 106 (50.23%) cases, of which 85 (80.18%) was performed Kapandji method. Follow-up results were assessed according W. Gartland and Werley L. score (2000). The study group consisted of 85 patients, of whom women - 52 (61.17%), men - 33 (38.83%). The mean age was 41 years. Results: according A. Kapandji classification in the study group were: type I - 2 cases, type II - 33 cases, type III - 3 cases, type IV - 13 cases, type V - 2 cases, type VI - 1 casetype VII - 1 case, type VIII - 9 cases, type IX - 15 cases, type X - 6 cases. K-wire ablation was performed at 35 days - 15 (17.6%) cases for I, II, IV types, at 40 days - 52 (61.2%) cases for II, V, VI types, at 45 days - 14 (16.5%) cases for III, VII, VIII, IX types and at 50 days - 4 (4 7%) cases for IX, X types. Follow-up results, according W. Gartland and L. Werley score, are positive in 84 (98.8%) cases of 85 patients. Excellent results (0-2 points) were 13 (15.3%) cases, good (3-8 points) - 41 (47.1%) cases, satisfactory (9-20 points) - 31 (36.5 %) cases. Conclusions: Intrafocal osteosynthesis with K-wire – Kapandji method constitutes a minimally invasive procedure favorable for treatment of distal radius fractures. The method is characterized by minimal intraoperative bleeding, low risk of postoperative complications and a good function and recovery

Closed K-wire method of proximal humerus fractures osteosynthesis

Institute of Emergency Medicine, Chișinău, Republic of Moldova, Raional Hospital of Rîșcani, Republic of Moldova, Al VIII-lea Congres Naţional de Ortopedie și Traumatologie cu participare internaţională 12-14 octombrie 2016Aim of the study: evaluation of the results of the surgical treatment by closed reduction, fixation with K-wires of fractures of proximal humerus in patients treated in IEM from Chisinau. Material and methods: during the period 2015-2016, 183 patients were examined and treated for fractures of the proximal humerus of different complexity levels. Out of the total number of patients, 50 (27,3%) patients underwent surgical treatment. Out of the total number of patients treated surgically, 13 patients were operated through the minimally invasive method with indirect reduction of the fracture and osteosynthesis with K-wires in closed fracture focus. The rest of the patients treated surgically 37 (20,2%) patients, underwent the open reduction, internal fixation through other methods described in specialty literature (ORIF). Results: the study group consisted of 13 (7,1%) patients. The average age was 59,53 years. Patients treated using minimally invasive method, the sex ratio being: women – 8 (61,5%) and men – 5 (38,5%) persons. Immediate results were appreciated according to postoperative radiological appearance, in 100% cases all the fractures united in axial alignment, it was appreciated as positive results. Follow-up results valued according to radiological appearance, full range motion of the traumatized shoulder joint in comparison with the contralateral (healthy) arm, and the quality of life: excellent and good in 10 (76,9%) cases, satisfactory – 2 (15,4%) cases and unsatisfactory – 1 (7,7%) case. It was determined the following complication – the inflammation around the K-wires in 3 cases. Conclusions: Osteosynthesis with K-wires in closed outbreak constitutes a favorable method for the surgical treatment of proximal humeral fractures. This method is characterized by reduced traumatologic trauma, minimal hemorrhage and minor risk of perioperative complications

Treatment results of open fractures of tubular bones

Institute of Emergency Medicine, Chișinău, Republic of Moldova, Al VIII-lea Congres Naţional de Ortopedie și Traumatologie cu participare internaţională 12-14 octombrie 2016The aim of the study: evaluation of the results of the treatment of open fractures of tubular bones in patients treated in the department of Ortopedics in the IEM from Chisinau. Material and methods: during the period 2015-2016, 48 patients were examined and treated for open fractures of the tubular bones. Out of the total number of patients, 91,7% of patients underwent surgical treatment. The sex ratio being: women – 21 and men – 27 persons, the average age was 48 years (21-85 y.o.). The distribution by fractured segments is: humerus -8, forearm bones -13, femur -5, shin bones -22 cases. The AO and Gustilo-Anderson classifications were applied. In 4 cases there were applied nonsurgical treatment. In the rest of the patients treated surgically, the distribution of methods of osteosinthesis was: ORIF -9; osteosinthesis by K-wires -9; Ilizarov’s method -11; external fixation -2 cases; locked intramedullary nailing -6; tension band wiring -2; amputation (MESS score 9 points) -1 case. Results: Immediate results were appreciated according to postoperative radiological appearance, in 97,91% cases all the fractures united in axial alignment, it was appreciated as positive results. Follow-up results valued according to radiological appearance, full range motion of the traumatized limb, and the quality of life: excellent and good in 42 cases, satisfactory – 2 cases and unsatisfactory – 4 cases. There were determined the following complications: joint stiffnes -2 cases, femoropatellar artrosis – 1 case, slow fusion -1 cases, infectious complications -2 cases, amputation – 1 case. Conclusions: There is a big incidence of open fractures of tubular bones. A lot cases of open fractures were treated in surgical way. The treatment for open fractures in the department of Orthopedics in IEM shows good results

Management of missed injuries in polytrauma patient

State University of Medicine and Pharmacy “Nicolae Testemițanu”, Republic of Moldova, Institute of Emergency Medicine, Chișinău, Republic of Moldova, Al VIII-lea Congres Naţional de Ortopedie și Traumatologie cu participare internaţională 12-14 octombrie 2016According CRICO Strategies, among the most common and costly medical errors committed in emergency departments are establishing a delay in diagnosis or misdiagnosis, which can have a tragic end for the patient. The management of multiple trauma patients presents a worldwide diagnostic and therapeutic challenge to trauma, orthopedic and general surgeons. Significant injuries can be missed during primary and secondary surveys in multiply injured patients, for whom resuscitation, diagnosis and therapy have to proceed simultaneously. Many factors involved in the initial resuscitation of the multiple trauma patients, such as altered level of consciousness, hemodynamic instability, or inexperience and inadequate diagnostic evaluation, may lead to missed injuries or a „medical errors”. The injuries can be missed at any stage of the management of the trauma patient, including intraoperatively, and may involve all regions of the body. Management of polytraumatised patient need application of primary and secondary survey protocols, as is the ATLS (Advanced Trauma Life Support) protocol, will minimize the chance of life-threatening critical medical errors. Also, intraoperative careful approach is needed for all patients, but especially for hemodynamically unstable patients, giving priority to other regions of the human body than appreciated as trauma, for the presence of vascular lesions. Examination of polytraumatised patient with special vigilance in a tertiary look, after patient returns to consciousness, will help detect missed lesions during the initial assessment. In most cases we detect missed lesions. This approach will lead to early detection of missed injuries and reduce lost their consequences