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DOI: http://dx.doi.org/10.20534/ESR-16-11.12-60-63
Karimov Murodullo Yuldashovich, Salokhiddinov Fakhriddin Bakhriddinovich Tashkent Medical Academy Department of "Traumatology-Orthopedics, Neurosurgery № 1" E-mail: [email protected], [email protected],
The experience treatment by the external fixation device of our design
Abstract: The apparatus for osteosynthesis of long bone fractures has several advantages comparing to the traditional treatment methods. The rod device is easy to use and comfortable for patients. We evaluated the efficiency of the rod device in patients with fractures of the long bones.
For the period from 2011 to 2015 25 patients with fractures of the femur and tibia with multiple and associated injuries were treated using the rod device of our design. The average age of patients was 43.4 years (range 19 to 68).
The results of the study investigated in all patients from 12 months to 26 months. The average period of fixation by the device depended on the appearance of signs of consolidation and the nature of fractures. The average term for type A was 12-14 weeks, for type B and C — 14-16 months (according to AO classification). Complete fusion was observed in 22 patients.
One patient had a bilateral fracture of the shin bone, which was not observed seam leg bones, this time treated. The second patient had improper splice of shin bone as a result of early device removal. Inflammation of soft tissue around the bone rod was observed in 3 (12%) cases, which managed by subcutaneous antibiotic injections around bone rods and frequent dressings.
The designed transosseus apparatus for osteosynthesis of long bone fractures on the basis of modern locks may be the method of choice.
The experience treatment by the external fixation device of our design
The use of the rod system for patients with multiple and associated injuries can achieve general stabilization and early mobilization of patients and the development of movement in the adjacent joints. Keywords: polytrauma, fractures, external rod.
Background
Multiple injury is a serious injury and it still remains as one of the main causes of death, in spite of advanced study of the problem. Mortality is observed up to 40%, disability reaches 28-50% that is mainly because of musculoskeletal system damage [1; 2; 3].
Stabilization of injured extremities plays an important role in multiple and associated injuries in order to save the patients lives, as well as to prevent possible complications, such as fat embolism and thrombosis, hypostatic pneumonia — especially in the elderly. All the measures should be less traumatic and with minimal stress for the patient. Fixation should be performed in a short period of time with minimal blood loss and minimal damage of main vessels. There should not be post fractural hematomas and patients have to be activated as early as it possible.
The external fixation device matches all the requirements above and allows to perform osteosynthesis of the fractures in several segments [5; 6; 7].
The purpose of our research was to investigate the efficiency of the external fixation device of our design in cases of lower extremities fractures.
Materials and Methods
The rod device has been developed (patent N FAP 00737 0019 from 08.06.12) in order to perform long tubular bones. The device has four arc blocks connected in pairs by threaded drawbars installed in the arms of the cantilever bar (1). The device has a central arc-shaped block with to longitudinal apertures (5, 6). The two threaded bars which connect the blocks are fixated along two sides of the apertures. The arms that have cantilever bars are fixated by drawbars (2). The block with apertures is longer than other blocks.
Figure 1.
For the period from 2011 to 2015 there were treated 25 patients with the fractures of the thigh and shin bones with multiple injuries using the rod device of our design. 6 of them were women (24%) and 19 were men (76%). The average age ofpatients was 43,4 (from 19 to 68). According to the AO classification the character of the fractures were: A1-4; A2-7; A3-2; B1-6; B2-4; C1-2;
Open fractures were in 5 (20%) and closed fractures were in 20 (80%) cases. By the mechanism of the trauma there were: road accidents 16 (64%), house injuries-7 (28%) and street injuries-2 (8%). All patients had a concomitant and multiple trauma: in 12 of them had been diagnosed with a closed head injury. 1 patient had intracranial injury and brain contusion. 2 patients had compression fracture of the body of lumbar and thoracic vertebrae, 2 patients had that of the pelvic bone. Two patients had broken ribs associated with he-mathorax. 2 patients had combined fracture of the femur and tibia. 1 patient had bilateral fracture of the shin bone. 15 patients were delivered with traumatic shock. The first degree was observed in 8 patients, the second degree of shock was observed 4 patients and 3 patients were diagnosed with the 3rd degree of shock.
Clinical and radiographic studies were carried out during the admission. Osteosynthesis was performed in the period from the first 6 hours to 10 days after injury. Intubation and spinal anesthesia is performed for the operative intervention. For the patients who had open fractures there were conducted initial surgical d-bridement
of wounds and osteosynthesis using rod device. For the patients with concomitant damage of the abdomen or limb vessels there was performed an operation by urgent indications in two teams — laparotomy with suturing parenchymal organs rupture and stabilization of long bone fractures by rod apparatus. Thoracentesis for diagnostic and therapeutic purposes was performed in 4 cases, when patients were suffered by the rupture of the lungs on the background of multiple fractures of ribs. Subdural hematoma was detected in one case.
The post-operative period was uneventful and patients received antibiotics according to the standard procedures. On the 2-3ld days after the application of the external fixation device, patients began to perform the movements of the hip, knee and ankle joints. The average length ofinpatient treatment was 10.6 days. On 2-3rd days, patients began active movement of adjacent joints and walked with crutches with metered load. The pain in the affected limb was clinically evaluated in patients, as well as the condition of the soft tissue around the rods.
Results and discussion
The final results were studied for all the patients. Hypostatic pneumonia was observed in 4 (16%) cases. Bedsores of sacral region were occurred in 3 cases (12%). Inflammation of the soft tissue around the bone was observed in 3 (12%) cases. All the complications were managed by sanation dressings and antibiotic therapy.
Long-term results of treatment studies have examined in all the cases from 12 months to 26 months. The control examination
was performed in every 8-10 weeks after discharge. Consolidation of fractures was evaluated by clinical and radiographic studies. The average period of fixation by external fixation device depended on the appearance of the signs of consolidation and the nature of the fracture. The average term for type A was 12-14 weeks, for type B and C — 14-16 months (according to AO classification). Complete fusion was observed in 22 patients.
2 patients had improper splice of the shin bones as a result of early device removal. Treatment outcomes were assessed by the system of E. R. Mattisa [15]. The study of long-term outcomes of the treated patients showed that in all cases positive results were good in 22 (88%), and found to be satisfactory in 2 cases (8%). An unsatisfactory result was recorded on 1 case (4%).
There is a clinical example for illustration.
Patient M., 56 years old, was injured in a traffic accident. A concomitant injury and closed craniocerebral injury were diagnosed.
Closed comminuted fracture of the middle third of the right shin bones with displacement of the fragments (according to the classification AO/ASIF — 42-B2.3 Figure 2). Transosseous osteosynthesis of the right shin bone by the rod device of our design was performed after 12 hours from the time of injury (Fig. 3). The residual displacement of the fragments detected on the X-ray, first rotary mixing was eliminated, then the width offset was eliminated by compression of the fragments. On the third day after the injury the patient was prescribed a course of rehabilitation. The postoperative period was uneventful, which allowed to discharge the patient on the 7th day from the hospital with a satisfactory range of motion in the joints of the damaged leg, the apparatus was removed after 14 weeks, (Fig. 4). There is a complete consolidation of the tibia and fibula at the control examination after 1 year on the control radiograph (Fig. 5). The patient had no complains while walking, motion in the knee and the ankle joints are complete, there is a good anatomical and functional results.
Figure 2. X ray of the patient before Fig. 3 X ray: after the operation
Figure. 4. X-ray of the patients after 14 weeks.
Discussion
The large arsenal of methods of treatment of long bone fractures with multiple and associated injuries does not satisfy the orthopedic surgeons and it makes them turn to look for the new methods of treatment [8; 9; 10; 11; 12]. Stabilization of fractures in case of multiple injury promotes early activation and prevention of secondary complications and it is of a great importance for patients. The
Fig. 5. X ray of the patient after a year
developed device retains the qualities of the other devices of external fixation: simple for application, a short time of surgical intervention, a small amount ofblood loss, less invasiveness, does not damage the feeder vessels, gives a stable fixation of bone fragments and holds the bone fragments from one side [13, 14]. In addition to the above features, the device allows to kep metal-bone distance throughout the limb due to its step-shape, which enhances stability and saves it
The combined use of acetylcysteine and 3% of sodium chloride in the nebulizer therapy of acute bronchiolitis
until the fusion of the bone fragments. Also, it reduces the load on the fracture site when the patient walks.
Conducting the early osteosynthesis oflong bones by the external fixation device in case ofmultiple and associated injuries has allowed the general stabilization ofthe patients and the early development ofmove-ments in adjacent joints. Also it prevents the appearance of hematoma at the fracture site and promoted the fusion of bone fragments. Rigid stabilization ofbone fragments eliminated the pain in the affected limbs, which contributed the early activation of patients and prevention of secondary complications and restore the anatomy of the affected limb.
Conclusion
The designed apparatus of transosseus osteosynthesis of long bone fractures based on rod mechanism of the known modern locks may be the method of choice in case of multiple injuries.
The use of the rod system for the patients with multiple and associated injuries allows to achieve the general stabilization ofpatients and early development of the movements in adjacent joints. The rod device helps to manage the displacement of bone fragments and provides a rigid fixation in the period of fusion, maintaining the joint function and it may widely used in traumatology and orthopedics.
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DOI: http://dx.doi.org/10.20534/ESR-16-11.12-63-66
Lim Maksim Viacheslavovich, Samarkand State Medical Institute Assistant Professor, Department of Children's Diseases № 1 E-mail: [email protected] Shavazi Nurali Mamedovich, Samarkand State Medical Institute Professor, Chief of Department of Children's Diseases № 1 E-mail: [email protected]
The combined use of acetylcysteine and 3% of sodium chloride in the nebulizer therapy of acute bronchiolitis
Abstract: Aim: to assess the effectiveness of the combined use of 10% acetylcysteine and 3% of sodium chloride in the nebulizer therapy of acute bronchiolitis in infants. 82 patients with acute bronchiolitis have been examined. In the I control group there were 21 patients who received traditional therapy, patients of the II-IV groups have received nebulizer therapy with
