Lianskorunskyi V. Substantiation of surgical treatment tactics of patients with multiple long bone fractures of lower extremities with severe associated trauma

The thesis deals with substantiation of surgical treatment tactics of multiple long bone fractures of lower extremities in polytrauma patients. In recent decades, much effort has been made to develop care strategies for patients with severe associated trauma and to implement appropriate treatment protocols in clinical practice. A question about the choice of methods and terms of long bone fracture osteosynthesis of lower extremities in polytrauma patients remains debatable. Numerous studies have described the safety of early definitive osteosynthesis, while its unjustified delay is accompanied by a high risk of pulmonary, thromboembolic, septic complications, increased length of stay, and increased economic expenditures. At the same time, literature presents a number of studies, results of which indicate that according to the theory of "the second hit", in combination with initial trauma, additional trauma as a result of early definitive surgery, exacerbates systemic inflammatory response (SIRS - systemic inflammatory response syndrome) and depletes body's compensatory capacity, which is directly associated with multiple physiological disorders, including organ dysfunction, unpredictable complications, and death of a polytrauma patient. A list of other, unresolved issues regarding the comprehensive assessment of patient's condition after polytrauma, determining most informative parameters that impact on complication development and mortality of this patient category, development of surgical treatment tactics, choice of optimal osteosynthesis methods and terms, some aspects of early rehabilitation determine the scientific and social significance of solving this problem at the current level of medicine development. The aim of the study: To improve treatment outcomes of patients with multiple long bone fractures of lower extremities and severe associated trauma by determining and substantiating of optimal surgery terms and methods depending on injury character, based on the comprehensive assessment of patient's general condition and respiratory function.