Abstract:
Background. Polytrauma meets the classification criteria for a global pandemic and it is a
significant cause of mortality and morbidity despite global efforts to control its effects. Around
16000 people in the world die every day as a result of trauma (5,8 million people per year) and
the forecast for 2020 is no better, the surveys show that this year there are expected around 8,4
million deaths. Management in polytrauma patients has been considerably changed in recent
years, due to the rapid development of multi-fracturing techniques. Despite the implementation
of good methods of diagnosis and treatment, there is no reduction in complications and
invalidations from trauma, which is explained by the severity of this injures. Without measures
to combat and improve treatment methods, they will lead to an increase in socio-economic
harm over the next 10 years. More than 70% of all patients with major trauma need at least
one orthopedic surgical procedure, and injures of the extremities are associated with higher
blood transfusion rates, prolonged hospitalization time and many other complications. The
modern treatment concept of Damage control surgery of poly-trauma patients allows us an
objective assessment and separation of urgent therapeutic measures according to the severity
of the injuries. Thus, osteosynthesis of traumatized segments of the locomotor system must be
performed according to this contemporary concept depending on the severity and complexity
of the lesions, and by achieving this attitude of urgent medical care, the damage control surgery
enables reduced mortality and the prevention of complications in polytrauma patients.
Case report. Patient X aged 63 years old got a trauma after she got involved as a pedestrian in
a car accident. She was immediately transported to IMSP-IMU in emergency department, she
being in a serious condition, hemodynamic unstable and without entrapment of the limbs and
the application of the fence, which led to massive blood losses. The patient was examined in
the red zone by the multidisciplinary team according to the principles ATLS, after a series of
lab and radiology investigations the diagnose that was established was the following:
Polytrauma. Associated traumatism. TCCI. Cerebral contusion. Bilateral lung contusion.
Hemopneumothorax on the left. Open fracture of the distal end of the femoral bone, tibial
plateau and of the fiber colt on the right. GA – type III C. Bimaleolar open-line fracture of the
right ankle. GA – type II. Fracture of left-hand olecranon, after AO – 2U1B1. Trauma shock
IIIrd grade. Acute polyorganic insufficiency. Sub-arachnoid hemorrhage. CGS – 5p MESS
score – 10p. Patient at admission: TA- 70/45 mm/Hg, Hemoleucocogram : Erythrocytes – 3,3
(x106/μl); Hemoglobin – 92 g/L; VSH – 15 mm/h; Platelets - 170 (x109μL); Leukocytes – 6,6
(x109/μl). In biochemical examination: ALAT – 147 U/I; ASAT – 366 U/I; direct Bilirubin -
8 mkmol/l; indirect Bilirubin - 14 mkmol/l; total Bilirubin – 22 mkmol/l; Creatinine – 119
mkmol/l; urea – 6,6 mkmol/l; Glycine – 8,1 mkmol/l. The patient was urgently transferred to
the operating room. The surgery team performed: thoracentesis in the intercostal space VI on
the left with the application of the Bullau drain. The team of orthopedic traumatologists
performed: The unfastening of the open fracture of both the bones of the left calf and the
fixation to the external tiered apparatus. Left lower leg amputation at thigh level in 1/3 middistal.
After these interventions, the patient was transferred to the reanimation room. More than
4 hours after the intervention, at the surgeons visit, he repeatedly indicates FAST USG, where
liquid is detected in the abdomen. The patient was taken in the surgery room repeatedly by the
surgical team, where they performed: Laparotomy. Ligaturation of the lymph duct in the
abdominal portion with revision of the abdominal cavity organs. The patient being in a severe
stable condition was transferred to The Reanimation room again. More than 48 hours after
hospitalization, the overall state is getting worse. On the background of major cardiomimetic
drugs, asystole cardiac arrest occurs at the patient. The CPR protocol has been initiated, but
without success, and it resulted in the patient's biological death.
Conclusions. Polytrauma describes patients with lesions that involve multiple regions or
cavities of the body that may compromise the integrity of the internal organs, extremities and
soft tissues, and may result in their death in most of the cases. In multi-traumatized patients,
rapid collaboration and effective multi-disciplinary team approach is needed, as negative
effects occur immediately and may endanger the life of the patient, and the “Orthopedic injury
Control” (DCO) allows us to use different types of fixatives in primary osteosynthesis in
polytrauma patients.
Description:
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 Doctors, September 24-26, 2020