Osteosynthesis methods in polytrauma with musculoskeletal system injuries

Abstract

Purpose: 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.