Trauma care and specialized treatment of injured patients with gunshot fractures of the humerus in the medical support system for Joint Forces Operation
DOI:
https://doi.org/10.14739/2310-1210.2020.4.208372Keywords:
limb combat injury, gunshot wounds, humeral fractures, reconstructive surgery, medical support levelsAbstract
Gunshot fractures of the humerus account for 20.3–22.3 % of all bone fractures. The problem of choosing the treatment tactics for the patients with gunshot fractures of the humerus is due to an the increase in their severity and increase in the frequency of complications requiring a lengthy reconstructive surgery.
The purpose of the work is to improve the treatment results of wounded patients with gunshot fractures of the humerus through the use of modern reconstructive and surgical procedures at the levels of medical support.
Materials and methods. The study cohort consisted of 110 wounded patients with gunshot fractures of the humerus. Using statistical analysis, the clinical effectiveness of reconstructive surgery implementation was determined.
Results. Trauma care was provided to the patients according to the principle of damage control: stopping external bleeding (33.6 %), anesthesia, antibiotic therapy, stabilizing the fracture with an external fixation device, and performing anti-shock measures. Debridement was performed after stabilization of the patients. Specialized treatment consisted of the differentiated soft-tissue defects replacement, the conversion of the fixation method, bone defects replacement, restoration of nerves and segment function. The incidence of shoulder and elbow contractures was reduced by 28.0 %, delayed consolidation – by 11.9 %, neurological disorders – by 14.9 % (Рα ˂ 0.05). The number of wounded patients who were dismissed from the Ukrainian Armed Forces for health reasons was reduced by 10.3 %.
Conclusions. Minimizing the time until start of reconstructive surgeries by reducing the levels of medical support is an important aspect in the treatment of wounded patients with gunshot fractures of the humerus with an improvement in the functional results, namely: an increase in the frequency of good ones by 20.2 %, a decrease in the relative number of unsatisfactory ones by 16.3 % (Рα < 0.05).
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