Osteosynthesis in extremely severe trauma in children

Abstract

Objective of study. To assess treatment tactics and technique in order to save the affected segment. Material and methods. This concept included children with injuries after severe trauma, which caused fractures and injuries so complicated that at the first stage the amputation of the segment was recommended. In the past 25 years, experts in the field were directed to refuse primary amputation, but to perform emergency anti-shock treatment and to carry the patient to the Institute of Mother and Child. The lot of clinical experience included 15 injured children aged between 4 and 18 years old. Only one girl suffered an extremely severe trauma of the upper limb, the rest of them (14) had fractures of the lower limbs, and 3 of them were found to have simultaneously fractures of the upper limbs. All patients had open fractures, III B degree of one or more segments, comminuted fractures, crushed soft tissues (even fingers in some children), very dirty major wounds. In 10 children the trauma occurred as a result of road accident (hit by car, wheel crossing over the lower limb or limbs), in 4 children there was trauma as a result of a massive concrete construction fall over the lower limb. In a girl the disaster followed after inattention while working with an electric meat grinder; the right hand with fingers II-III-IV-V was stuck in the grinding space and broken in the “drum” with all finger and hand tendons. This was the only case where it was not possible to restore the affected segment. The rest of injured patients were subjected to primary surgical wound treatment with removal of non-viable tissue and washout with hydrogen peroxide, furacilin, aminocapronic acid, adaptation of fragments, fixation with pins or external devices, wound suturing or open wound treatment under the dressing. The follow-up treatment was lengthy; when indicated, the following measures were performed - staged necrectomy, skin plasty and bone reconstruction. No amputation was performed in any case. Conclusion. Regardless of the extent of injury of the child`s affected segment, specialists in the field should make maximum effort to save the segment and avoid amputation.