Baychuk B. Application locking intramedullary nailing in the treatment of patients with lower limb fractures in polytrauma

Thesis deals with the topical problem of Orthopedics and Traumatology - improving treatment strategy for patients with fractures of the long bones of the lower extremities with polytrauma due to differentiated use of blocking intramedullary osteosynthesis. The work is based on comparative analysis of the effectiveness of diagnosis and treatment of 120 patients with polytrauma using locking intramedullary nailing and 62 patients on whom traditional MOS plates osteosynthesis of femoral and tibial bones was performed and high efficiency of the first method was proved. It was analyzed the significantly higher severity of changes in general clinical and biochemical parameters of victims'blood on whom osteosynthesis was performed immediately after the injury and MOS plates osteosynthesis were applied. The importance of identifying the dynamics (before and after the operation) the concentration of C-reactive protein, ceruloplasmin and haptoglobin in the serum of patients'blood was proved in order to assess the severity of the systemic inflammatory response, get a picture acute phase protein response in the development of inflammation in theearly stages of the disease in multiple trauma. It was determined that the decline in ceruloplasmin below 98% from normal level with the improvement of the C-reactive protein is unfavorable prognostic sign of infectious postoperative complications.It is shown that the initial fixation in the treatment of patients with polytrauma in an unstable, boundary and critical state according to the classification of Pape and Krettek (2003) must be made during the first day and the final reposition of bone fractures is accomplished after 7 days from the date of injury when laboratory indicators improve. The locking intramedullary nailing should be conducted for patients with stable condition during the first day after the injury. This paper proposes a new algorithm of using locking intramedullary nailing of femoral and tibial bone for patients with polytrauma, that is based on the severity of the state considering the concentration of C-reactive protein and ceruloplasmin, concomitant injuries and the type of fracture. The using of the developed indications for using locking intramedullary nailing based on the general condition of the patients, clinical and laboratory parameters of homeostasis, the severity of damage to the affected bone segment limb prognosis of inflammatory complications, allowed to get 89,1% good, 9,2% satisfactory and 1,7% unsatisfactory outcomes of treatment.