Polytrauma ( multiple injuries )
Traumatology / / August 12, 2017
polytrauma Under the generic term must be understood a combination of two or more injuries requiring specialized treatment;the last character depends on the characteristics of each of the damage and of their mutual influence on the body of the victim.
There are three main forms of polytrauma: multiple fractures;associated injuries;Combined lesions.For all types of polytrauma syndrome characterized by the development of mutual burdening significantly worsens the prognosis for the restoration of one or more bodily functions (eg, musculoskeletal when polifrakturah) or the very life of the victim.
Syndrome mutual burdening - a complex of symptoms indicating a more severe course of the pathological process associated with each of the associated injuries, compared with the clinical picture, characteristic for similar isolated damage.
term multiple fractures (polifraktury) should be marked fracture within a bone within a single limb segment (monostatic fractures) within two or three segments of one limb
combines called damage of two or more different anatomical and functional areas.The most common combinations are fractures of the locomotor system with lesions of the internal organs of the abdomen and chest, with a traumatic brain injury, spinal cord injury, as well as damage to the great vessels, the large nerve trunks, with extensive destruction of soft tissue, significantly aggravating prognosis for lifethe victim, and to repair damaged limb function.
Combined closed or open lesions several bones, soft tissues and surrounding internal organs (including the large blood vessels and nerves) in one area should be seen as a traumatic hearth.Such traumatic foci in severe multiple traumas may be more than one (eg, dual damaged ribs, sternum, lung and liver on the one hand, or - the bones of the pelvis, bladder and intestines, etc...).The term «traumatic hearth» involves some mechanism of injury, the pathological changes of damaged tissues and causes the simultaneous treatment of complex, specific to the damage of the hearth.
Combined defeat - it defeats inflicted by the combined action (simultaneously or sequentially) in several affecting factors -. Mechanical, radiation, thermal, chemical, biological, etc. For combined lesions, as well as for all other polytrauma, characterized by mutual syndromecomplications or synergistic effect.These lesions are characterized by a great clinical severity and high mortality.Their frequency in the structure of peacetime trauma is small, but they can be among the leading battle damage.
have suffered multiple fractures with only 22.2% at the same time there are not heavy concussion, which, however, do not affect the tactics and methods of treatment polifraktur.In patients with combined lesions in 46.8% observed severe traumatic brain injury (contusion, compression, brain destruction), which is the leading cause of severe, often critical states, especially in patients with concomitant severe chest injuries (28.9%)pelvis (25.5%) of the spine (21.1%).Different severity of internal abdominal organ injury in patients with combined injuries are on average 28.8%.In view of the brain damage and organ chest every patient with this type of polytrauma is between 1.2 and 3.8 damaged internal organs.Among the survivors damage to the internal organs of the abdomen observed in 22.2%, among the dead - in 82.3%.
Traumatic shock of varying severity is observed in 19.8% of patients with multiple injuries.Development of shock, especially heavy, completely determined by the participation in multiple trauma injuries of internal organs, massive blood loss, acute respiratory failure.Thus, among the affected limb with only polifrakturami shock occurs in 6.5%, the presence of severe traumatic brain injury and chest injury increases the incidence of shock, up to 28%.Related internal injuries requiring immediate surgery, dramatically increase the number of victims in a state of shock, up to 86%;suffered a massive, irreversible multiple injuries of the head, chest, abdomen, pelvis (in various combinations) are usually delivered in a state of dire shock (III-IV degree).
Mortality in multiple fractures associated with fat embolism, pneumonia, suppurative complications, comorbidities.
in mortality when combined injuries play a leading role: acute hemorrhage, severe brain injury, acute respiratory failure, at least - other reasons.
Retrospective analysis of clinical data with respect to the selected causes of mortality allows more objectively evaluate the diagnostic accuracy, timeliness and quality of the various therapeutic measures.
Types of fractures
designation of multiple fractures and associated injuries
and - monostatic fractures (within a bone or one segment);
b, c, d - monomelicheskie fractures (within one limb);
d, f, g - intra-articular and periarticular polifraktury;
s - «traumatic nodes" or "traumatic lesions."
Dimelicheskie fractures: and to - sided;
l, m - cross. district, about - symmetrical;
n, p - asymmetrical. with - multiple unilateral;
t - fractures and traumatic brain injury; in - polifraktury bones of the body;
£ - symbols limb segments: 1 - shoulder;2 - the forearm;3 - Brush;4 - hip;5 - shin;6 - foot.The arrows indicate the localization of fractures.
- Principles diagnosis polytrauma
- Multiple rib fractures
- Multiple fractures pelvis
- Multiple fractures of foot
- Multiple fractures of femur
- Multiple fractures of the tibia
- Multiple fractures anklejoint
- multiple fractures of the bones of the knee joint
- multiple fractures of the bones and the bones of one segment
- clinical picture of multiple fractures pelvis
- Combined treatment of injuries
- treatment of multiple rib fractures
Nomenclature multiple fractures conveniently representedin the form of 16 items:
1) multiple fractures within the same bone - double, triple, comminuted;
2) multiple fractures within the same segment of a limb, two or more bones, including sesamoid bones;
3) similar unilateral fractures, occurring simultaneously in such (single or double) segments of the upper and lower limbs (fractures of the forearm and lower leg on one side);
4) unilateral dissimilar fractures (bone of the forearm and hip, wrist and hip, leg and shoulder, foot and shoulder);
5) multiple unilateral fractures (bones of the skull, pelvis and limbs on one side of the body);
6) multiple intraarticular fractures (bone that make up the joint);
7) multiple periarticular fractures;
8) similar to the cross-bone fractures of two segments - one on the top, and the other - on the lower limb on the opposite side (hip - shoulder, upper arm - lower leg);
9) cross dissimilar bone fractures (femur - forearm, upper arm - lower leg);
10) symmetrical bone fractures of the same name - on the same level (both thigh bones in the middle third of the diaphysis);
11) conditionally symmetrical bone fractures of the same name - on a different level (a bone in the distal forearm, the other - in the proximal);
12) asymmetric fractures of both lower or both upper extremities (femur - shin, shoulder - forearm);
13) multiple fractures of three or four limbs;
14) is combined fractures of the extremities (with injuries of the skull, chest, abdomen, pelvis, and their bodies);
15) multiple fractures of the body - the chest, spine and pelvis in various combinations;
16) associated injuries skull, chest, spine, the abdomen or pelvis combinations in various embodiments, including fractures and limbs.