Traumatology / / August 12, 2017
traffic injuries occur mostly in men (72.2%) of working age from 21 to 50 years (71.2%).On the mechanism of this injury are three groups of victims:
1) pedestrian hit by vehicles - 61.1%;
2) drivers and passengers of cars wrecked, - 30.4%;
3), motorcyclists and cyclists, had an accident - 8.5%.
When accidents often damaged limbs (88.6%).Frequency limbs pedestrian injuries is 98.0%, motorcyclists - 89.2% of drivers - 69.7%.It is also different in nature and limb injuries.The most serious injuries occur in motorcyclists: comminuted (shattered) fractures, crushing, detachments.Drivers arise mainly closed fractures with a small area of soft tissue damage.Pedestrians ratio of public and private damage roughly equal, in contact with the limb under the wheel comes extensive skin detachment, separation of the muscles from the bones, which can remain intact.This injury is very difficult to treat, because, on the one hand, it clinically in the first few hours is weak, and the next day already can develop e
Typical injuries of pedestrians are multiple fractures of the shin bone (63.5% of the lower extremities polifraktur).As a result, direct injuries occur more frequently open fractures (74.1%), however, and closed strong polifrakturah skin injury and soft tissue to be almost 20% leads to skin necrosis in the area of the fracture.Pedestrians are more likely than the other groups, there are a few segments of the limb fractures (29.2% of patients with limb polifrakturami).Certain difficulties for diagnosis are a combination of fractures of the proximal femur and the middle or distal parts of tibia (especially open), because the latter camouflage, break and even distort the symptoms characteristic of the disease in the hip.Clinically more pronounced tibia fractures (comminuted open with large displacement of bone fragments), usually distracting the attention of the patient and medical staff from the less pronounced in the trochanteric fractures of the hip area.Sprains and fractures in the hip joint can be expected in automobile drivers.
analysis of diagnostic errors shows that fractures - "invisible" during transport polytrauma are fractures of the ankles, subluxation of the talus, sprains and fractures of the foot, dislocations and subluxations of the acromial end of the clavicle, sprains heads the radius and ulna in injuries Montedzha and Galeazzi, fractures and dislocations of the wrist bones.
second place in frequency takes a traumatic brain injury (44.8%), motorcyclists, it is 96.6%, pedestrians - 43.2% of drivers - 33.3%.The same distribution pattern and marked on the severity of brain damage.Coma, observed more frequently among motorcyclists and pedestrians limits the active treatment of injuries of the musculoskeletal system, but it should not prevent the carrying out of the most active diagnosis of life-threatening traumatic lesions and no less dangerous complications of polytrauma.
chest injuries are more common in drivers (34.5%) and motorcycles (31.1%), at least - pedestrians (14.3%).In patients with thoracic trauma, in addition to the classic complications of hemodialysis and pneumothorax, marked damage (bruises, fractures) of the heart (21.6%) and lung (56.3%), and the drivers frequency of these injuries up to 34% and 793%, respectively.In 1.2% of cases identified transport polytrauma heart injuries have affected them direct without causing trauma to the chest.This fact proves the importance of a thorough cardiac examination of all the victims of road traffic accidents.
Multiple pelvic fractures observed in 27.3% of all victims, more often - pedestrians (34.7%), at least - in drivers (14%).The most severe, unstable pelvic fractures occur from the action of high compressive strength when hit a pedestrian under the wheels or between the car and any obstacle.The resulting traumatic hearth with massive bleeding in the retroperitoneal space, as a rule, is a leading tanatogenesis;it is only possible to suspend the active urgent treatment;loss of time to clarify the diagnosis and diagnosis is not life-threatening injuries these victims are almost always disastrous.
- Multiple fractures of femur
- Bilateral femoral fractures
- damage to abdominal organs and limbs
- abdominal organ injuries
- Injuries in the home and at work
- struggle with pain in injuries
- bilateral hip dislocations
- tourniquet technique
- Transosseous osteosynthesis external fixation
- struggle with acute blood loss in trauma
Injuries to the abdomen of all damages up to 10.2%, mainly they are closed.A bit more often these injuries occur in motorcyclists (18.2%), but in absolute terms, half of patients with abdominal injuries accounted for pedestrians.Injuries parenchymal organs (56.7%) prevail over the hollow injuries (44%).About diagnostic difficulties of closed internal injuries evidenced by the fact that 40.1% of victims diagnosis is delayed.
As part of the transport polytrauma rarest are the spine injury (3.9%), they are mainly observed among drivers of cars with the typical localization in the cervical and thoracic spine.
Injuries from rail transport are characterized by predominantly heavy injuries of limbs, crushing and tearing them.Most affected both lower limbs, at least a combination of injuries the lower and upper extremities is observed.