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).
References
Zarutskyi, Ya. L., & Bilyi, V. Ya. (Eds.). (2018). Voienno-poliova khirurhiia [Military field surgery]. Feniks. [in Ukrainian].
Khomenko, I. P. (Ed.). (2019). Nastanova z medychnoho zabezpechennia Zbroinykh Syl Ukrainy na osoblyvyi period [Guidelines for medical support of the Armed Forces of Ukraine for a special period]. Vydavnytstvo Liudmyla. [in Ukrainian].
Omid, R., Stone, M. A., Zalavras, C. G., & Marecek, G. S. (2019). Gunshot Wounds to the Upper Extremity. The Journal of the American Academy of Orthopaedic Surgeons, 27(7), e301-e310. https://doi.org/10.5435/JAAOS-D-17-00676
von Lübken, F., Achatz, G., Friemert, B., Mauser, M., Franke, A., Kollig, E., Bieler, D., & AG Einsatz-, Katastrophen- und Taktische Chirurgie der Deutschen Gesellschaft für Unfallchirurgie (2018). Update zu Schussverletzungen der Extremitäten. Der Unfallchirurg, 121(1), 59-72. https://doi.org/10.1007/s00113-017-0449-4
Pannell, W. C., Heckmann, N., Alluri, R. K., Sivasundaram, L., Stevanovic, M., & Ghiassi, A. (2017). Predictors of Nerve Injury After Gunshot Wounds to the Upper Extremity. Hand (New York, N.Y.), 12(5), 501-506. https://doi.org/10.1177/1558944716675294
Amri, K., Chefi, M. A., Znagui, T., Rafrafi, A., Saadi, S., & Nouisri, L. (2019). Resurfacing shoulder hemi arthroplasty in ballistic injuries. A case report. International journal of surgery case reports, 65, 48-51. https://doi.org/10.1016/j.ijscr.2019.10.027
Auld, T. S., Hwang, J. S., Stekas, N., Gibson, P. D., Sirkin, M. S., Reilly, M. C., & Adams, M. R. (2017). The Correlation Between the OTA/AO Classification System and Compartment Syndrome in Both Bone Forearm Fractures. Journal of orthopaedic trauma, 31(11), 606-609. https://doi.org/10.1097/BOT.0000000000001020
Bauhahn, G., Veen, H., Hoencamp, R., Olim, N., & Tan, E. (2017). Malunion of Long-Bone Fractures in a Conflict Zone in the Democratic Republic of Congo. World journal of surgery, 41(9), 2200-2206. https://doi.org/10.1007/s00268-017-4008-5
Mehta, S. K., Dale, W. W., Dedwylder, M. D., Bergin, P. F., & Spitler, C. A. (2018). Rates of neurovascular injury, compartment syndrome, and early infection in operatively treated civilian ballistic forearm fractures. Injury, 49(12), 2244-2247. https://doi.org/10.1016/j.injury.2018.10.009
Vuoncino, M., Soo Hoo, A. J., Patel, J. A., White, P. W., Rasmussen, T. E., & White, J. M. (2020). Epidemiology of Upper Extremity Vascular Injury in Contemporary Combat. Annals of vascular surgery, 62, 98-103. https://doi.org/10.1016/j.avsg.2019.04.014
Gustilo, R. B., Mendoza, R. M., & Williams, D. N. (1984). Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. The Journal of trauma, 24(8), 742-746. https://doi.org/10.1097/00005373-198408000-00009
Kholeif, A., Elnahal, W., & Gobba, M. (2016). The orthopaedic experience of Kasr Al Ainy Hospitals in the Egyptian revolution. European journal of trauma and emergency surgery, 42(1), 97-100. https://doi.org/10.1007/s00068-015-0501-4
Engelmann, E., Roche, S., Maqungo, S., Naude, D., & Held, M. (2019). Treating fractures in upper limb gunshot injuries: The Cape Town experience. Orthopaedics & traumatology, surgery & research, 105(3), 517-522. https://doi.org/10.1016/j.otsr.2018.11.002
Nguyen, M. P., Como, J. J., Golob, J. F., Jr, Reich, M. S., & Vallier, H. A. (2018). Variation in treatment of low energy gunshot injuries - A survey of OTA members. Injury, 49(3), 570-574. https://doi.org/10.1016/j.injury.2018.01.027
Downloads
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
