Abstracts journal "Polytrauma" 1/2017

Secondary care organization
THE ACTUAL ISSUES OF ASSOCIATED INJURIES (FROM THE MATERIALS OF POLYTRAUMA
JOURNAL)
Inozemtsev E.O., Grigoryev E.G., Apartsin K.A

Inozemtsev E.O., Grigoryev E.G., Apartsin K.A. Irkutsk Scientific Center of Surgery and Traumatology,
Irkutsk State Medical University,
Irkutsk, Russia

Objective – to analyse the materials of the publication of Polytrauma journal dedicated to the main
problems of arrangement of medical care for patients.
Materials and methods. The study presents the review of the articles published in Polytrauma journal for
10 years.
The importance of the problem of treatment of patients with severe associated injuries is accentuated. The
main attention has been given to the main problems of treatment such as transportation, estimation of
severity of patient’s condition, damage control concept and the concept of trauma centers.
Results. The main way for decreasing mortality in this group of patients is adherence to the clear
organizational and diagnostic algorithm, and treatment on the basis of the level 1 trauma center for
specialized medical aid.
Conclusion. Arrangement of medical care for patients with polytrauma is one of the actual sections of the
modern medicine with necessity of the multidisciplinary approach. The problem requires solving several
key issues: the problem of transportation, estimation of injury severity and, the main thing, where and how
to treat the patient with associated injury and who should perform treatment.
Key words: polytrauma; associated injury; severity of condition; severity of injuries; estimation of injury
severity; damage control; trauma center; arrangement of medical care.

Information about authors:
Inozemtsev E.O., postgraduate, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia.
Grigoryev E.G., corresponding member of Russian Academy of Science, scientific supervisor, Irkutsk
Scientific Center of Surgery and Traumatology, chief of hospital surgery chair, Irkutsk State Medical
University, Irkutsk, Russia.
Apartsin K.A., MD, PhD, professor, chief researcher, Irkutsk Scientific Center of Surgery and
Traumatology, professor of hospital surgery chair, Irkutsk State Medical University, Irkutsk, Russia.
Address for correspondence:
Inozemtsev E.O., Bortsov Revolyutsii St., 1, Irkutsk, Russia, 663003
E-mail:77eugene@rambler.ru

References:

1. Agadzhanyan VV, Kravtsov SA. Polytrauma, the ways of development (terminology). Polytrauma.
2015; 2: 6-14. Russian
2. Agadzhanyan VV, Kravtsov SA, Zheleznyakova IA, Kornev AN, Pachgin IV. Integration of criteria
of polytrauma severity degrees into the international classification of diseases. Polytrauma. 2014; 1:
6-15. Russian
3. Agadzhanyan VV. Organizational problems of delivery of care for patients with polytrauma.
Polytrauma. 2012; 1: 5-10. Russian
4. Agadzhanyan VV, Agalaryan AKh. Scientific organizational technologies of medical aid realization
for victims with polytrauma with dominant injuries to internal organs. Polytrauma.2012; 3: 5-10.
Russian
5. Agadzhanyan VV, Shatalin AV, Kravtsov SA, Skopintsev DA. Estimation criteria of state severity in
patients with polytrauma during interhospital transportation. Polytrauma. 2011; 1: 5-11. Russian
6. Agadzhanyan VV. The factors influencing on lethality in patients with polytrauma. Polytrauma.
2010; 3: 5-7. Russian
7. Agadzhanyan VV, Agalaryan AKh. Damage control laparotomy in combination with damage control
reanimation in patients with abdominal injuries in polytrauma. Polytrauma. 2011; 2: 5-9. Russian
8. Agadzhanyan VV, Pronskikh AA. To the question about tactics of management of patients with
polytrauma. Invitation to discussion. Polytrauma. 2010; 1: 5-8. Russian
9. Agadzhanyan VV, Pronskikh AA. To the question about tactics of management of patients with
polytrauma. Invitation to discussion. Polytrauma. 2010; 2: 5-9. Russian
10. Agadzhanyan VV. Polytrauma: problems and practicalities. Polytrauma. 2006; 1: 5-8. Russian
11. Agadzhanyan VV, Shatalin AV, Kravtsov SA. Organisational-tactical aspects of interhospital
transportation of patients with polytrauma in critical condition. Polytrauma. 2006; 1: 23-27. Russian
12. Agadzhanyan VV, Kravtsov SA, Shatalin AV, Levchenko TV. Hospital mortality in polytrauma and
main directions for its decrease. Polytrauma. 2015; 1: 6-15. Russian
13. Agalaryan AKh. Surgical treatment and mortality in patients with abdominal injuries in polytrauma.
Polytrauma. 2014; 4: 24-31. Russian
14. Anikeev NV, Shchedrenok VV, Zuev IV, Potemkina EG, Sebelev KI, Moguchaya OV. Experience
of use of tactics “damage control” in craniocerebral and spinal trauma. Polytrauma. 2013; 1: 12-19.
Russian
15. Dubrov VE, Blazhenko AN, Khanin MYu, Gorbunov IA, Blazhenko AA, Kobritsov GP, et al.
Realization of damage control concept in acute period of polytrauma. Polytrauma. 2012; 2: 68-73.
Russian
16. Koltovich A, Pfeifer R, Ivchenko D, Almahmoud Kh, Pape HC. Damage control surgical approach
in civilian and military settings. Polytrauma. 2014; 4: 6-16. Russian
17. Novozhilov AV, Kosenkova DV, Zaytsev AP, Apartsin KA. MOST: monitoring of the traumatism
in combined mechanical injuries. Polytrauma. 2007; 1: 9-15. Russian
18. Plekhanov AN, Nomokonov IA, Shagdurov VA. Organizational and tactical aspects of rendering
assistance for patients with concomitant injury in current conditions (surgery of concomitant injury).
Report 2. Polytrauma. 2008; 1: 59-63. Russian
19. Sokolov VA, Byalik EI, Shchetkin VA, Sharipov IA, Klopov LG. The experience with arrangement
of activity of the associated injury department. Polytrauma. 2006; 3: 9-14. Russian
20. Skopintsev DA, Kravtsov SA, Shatalin AV. New approaches to using kashtan anti-shock suit during
interhospital transportation of patients with polytrauma. Polytrauma. 2014; 2: 21-25. Russian
21. Shatalin AV, Kravtsov SA, Interhospital and prehospital transportation of critically ill patients.
Polytrauma. 2009. 1: 18-22. Russian
22. Shatalin AV, Agadzhanyan VV, Kravtsov SA, Skopintsev DA. Medical transportation for patients
with polytrauma. Polytrauma. 2008; 1: 24-31. Russian

Original researches
CRANIOCEREBRAL DISPROPORTION IN CHILDREN WITH TRAUMATIC BRAIN INJURY
Larkin V.I., Koval R.P., Novokshonov A.V., Dolzhenko D.A.

Omsk State Medical University,

City Pediatric Clinical Hospital No.3, Omsk, Russia,

Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia,

Regional Clinical Hospital, Barnaul, Russia

Objective – to develop the way of the calculation of the optimum volume of decompressive trepanation of the skull in children with different mass-effect of the trauma with consideration of the individual
craniometrical parameters.
Materials and methods. 182 children with traumatic brain injury (TBI) of different severity, the age of 3-
15, were examined for the main intracranial components by means of CT-morphometry.
Results and discussion. The mass-effect increases along with increasing severity of TBI. The mass-effect
was not identified in a mild injury. The mass-effect of a middle severity injury is 2.5 ± 1.3 %, a severe
injury – 13 ± 9.1 %, intracranial hematoma – 10.7 ± 4 %. The statistically significant (p < 0.05) symptoms
of increasing volume of the intracranial components were identified.
Conclusion. The volume of trepanation can be calculated by means of the known sizes of the head
circumference and the value of mass-effect with use of offered formulae.
Key words: mass-effect of injury; optimal volume of trepanation.

nformation about authors: Larkin V.I., MD, PhD, chief of chair of neurology and neurosurgery, Omsk State Medical University,
Omsk, Russia.
Koval R.P., candidate of medical science, City Pediatric Clinical Hospital No.3, Omsk, Russia.
Larkin I.I., MD, PhD, professor, chair of neurology and neurosurgery, Omsk State Medical University,
Omsk, Russia.
Novokshonov A.V., MD, PhD, chief of neurosurgery department No.2, Regional Clinical Center of
Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Dolzhenko D.A., MD, PhD, professor, chief of neurosurgery department, Regional Clinical Hospital,
Barnaul, Russia.
Address for correspondence:
Larkin V.I., 50 let profsoyuzov St., 114-91, Omsk-53, Russia, 644053
Tel: +7 (913) 152-34-36
E-mail: larkin_valery@mail.ru

References:

1. Artaryan AA, Banin AV, Gaevoy OV. Severe traumatic brain injury in children: the guidelines. M.:
Meditsina, 1984. P.14. Russian
2. Parfenov EV, Svistova DV. The lectures in neurosurgery. Saint Petersburg: OOO Izdatelstvo Foliant,
2004. P. 336. Russian
3. Kondakov EN, Semenyutin VB, Gaydar BV. Severe traumatic brain injury (functional and structural
range of the region of cerebral crushing injury and types of surgery. Saint Petersburg: RNKhIL., 2001.
P.2016. Russian
4. Shchedrenok VV, Moguchaya OV, Zakhmatov IG, Sebelev KI. Cerebral dislocation: clinical and
radial diagnostics and pathomorphology. Saint Petersburg, 2016. P. 487. Russian
5. Safin ShM. The features of clinical manifestations in liquor dynamic disorders and results of surgical
correction in Arnold-Kiari anomaly. In: III convention of Russian neurosurgeons: the materials of
convention. Saint Petersburg, 2002. P.53. Russian
6. Nikolaev AS, Novokshonov AV, Agadzhanyan VV. Surgical treatment of patients with posttraumatic
cysts of the brain. In: III convention of Russian neurosurgeons: the materials of convention. Saint
Petersburg, 2002. P.53. Russian
7. Grin AA. Treatment technique for intracranial traumatic epidural and subdural small hematomas (up
to 50 cm
3
) of supratentorial location: abstracts of candidate of medical science. M. 1999. P.21.
Russian
8. Krylov VV, Talypov AE, Puras YuV. Choice of trepanation in surgery of severe traumatic brain injury. The Journal “Issues of Neurosurgery” named after N.N. Burdenko. 2007; (1): 11-16. Russian 9. Larkin VI, Ignatyev YuT, Larkin II. Morphometry of the brain in children with normal characteristics
and with pathology according to radiographic computer tomography. Medical Visualization. 2005;
(5): 129-133. Russian

New medical technologies
DEVELOPMENT OF HIP ENDOPROSTHESIS FOR TREATING PATIENTS WITH FEMORAL
NECK PSEUDARTHROSIS

Varfolomeev D.I., Samoday V.G.

Voronezh State Medical University named after N.N. Burdenko, Voronezh, Russia

Femoral neck fractures and their consequences represent a serious problem of modern traumatology and orthopedics. Hip joint replacement is one of the effective methods to treat this pathology. Significant
shortening of a limb in case of the femoral neck pseudarthrosis is accompanied by technical difficulties in
surgery.
Objective – to develop the original hip prosthesis for improving outcomes of joint replacement in patients
with femoral neck pseudarthrosis.
Materials and methods. The present model of the endoprosthesis was developed with 3d modelling at the
basis of the chair of traumatology and orthopedics, Voronezh State Medical University named after N.N.
Burdenko. The implant has a possibility for non-invasive change in the length of the extremity and
antetorsion of the neck by means of external magnetic field during the postsurgical period.
Results. The experimental test bench studies of the prosthesis model demonstrated the possibility to
change the length of the protruding part of the implant neck, as well as to perform its antetorsion under
exposure of the alternating magnetic field to the femoral component of the prosthesis.
Conclusion. The functional capabilities of the implant allow reducing the surgical injury and, accordingly,
the number of complications of hip replacement surgery.
Key words: hip endoprosthesis; femoral neck pseudarthrosis; femoral neck fracture; limb length;
antetorsion

Information about authors: Varfolomeev D.I., traumatologist-orthopedist, student of chair of traumatology and orthopedics,
Voronezh State Medical University named after N.N. Burdenko, Voronezh, Russia.
Samoday V.G., chief of chair of traumatology and orthopedics, Voronezh State Medical University
named after N.N. Burdenko, Voronezh, Russia.
Address for correspondence:
Varfolomeev D.I., Chapaeva St., 120-106, Voronezh, Russia, 394031
Tel: +7 (917) 511-31-17
Е-mail: d.i.burdenko@yandex.ru

References:

1. Ezhov MY, Ezhov IYu, Kashko AK. The features of hip joint replacement in false joints of femoral
neck. Medical Almanac. 2015; 3 (38): 234-237. Russian
2. Reshetnikov AN, Reshetnikov NP, Kovaleva ID, Goryakin MV, Adamovich GA, Kireev SN. The
features of changes in general integrative values of function of lower extremities after surgical treatment of patients with false joints of femoral neck. Herald of New Medical Technologies. 2011; 18 (3): 129-133. Russian
3. Estrada LS, Volgas DA, Stannard JP, Alonso JE. Fixation failure in femoral neck fractures.
ClinOrthopRelat Res. 2002; 399: 110-118.
4. Pingle J. Transfracture abduction osteotomy: a solution for nonunion of femoral neck fractures.
IndianJOrthop. 2014; 48: 25-29.
5. Shpakovskiy MS, Kazanin KS, Basov AV, Gribanov NI, Ardashev IP, Nikitenko EV. Use of
perftorane and bioactive implants with calcium-phosphate coating for surgical treatment of
experimental fractures of femoral neck. Herald of New Medical Technologies. 2015; 22 (3): 73-79.
Russian
6. Kopysova VA, Kaplun FV, Nysymbaev RS, Tuzovskaya TA, Dugina EN, Fedorkina DV.
Reconstructive surgery for fractures and false joints of femoral neck. Herald of NSU. Series: Biology,
Clinical Medicine. 2009; 7 (3): 99-103. Russian
7. Azizov MZh, Usmonov FM, Stupina NV, Karimov KhM, Mirzaev ShKh. Our experience with
endoprosthetics for fractures and false joints of femoral neck in patients of elderly and senile age.
Orthopedics, Traumatology and Prosthetics. 2013; 1: 16-19. Russian
8. Roshan A, Ram S. The Neglected Femoral Neck Fracture in Young Adults: Review of a Challenging
Problem. Clin Med Res. 2008; 6: 33‑39.
9. Blomfeldt R., Tornkvist H., Ponzer S. et al. Comparison of internal fixation with total hip replacement
for displaced femoral neck fractures. randomized, controlled trial performed at four years. J. Bone
Joint Surg. Am. 2005; 87(8): 1680–1688.
10. Varfolomeev DI. Hip joint endoprosthesis. The patent of RF No. 2593224, August 10, 2015. Russian
11. Gupta A, Meswania J, Pollock R, Cannon SR, Briggs TW, Taylor S, et al. Non-invasive distal
femoral expandable endoprosthesis for limb-salvage surgery in paediatric tumours. The journal of
bone and joint surgery (Br). 2006; 88(5): 649-654.

Anesthesiology and critical care medicine
PREVENTION OF FAT GLOBULEMIA IN TOTAL HIP JOINT REPLACEMENT
Lebed M.L., Bocharov S,N., Golub I.E., Kirpichenko M.G., Karmanova M.M.

Irkutsk Scientific Center of Surgery and Traumatology,

Irkutsk State Medical University, Irkutsk

Objective – to investigate the efficiency of prevention of fat globulemia syndrome in total hip joint replacement with use of the drugs: Hepasol-Neo, 5 % ethanol, Essentiale N.

Materials and methods. Three groups of patients were formed. The patients received total hip joint replacement. For prevention of fat globulemia 70 patients of the first group received Hepasol-Neo, 85 patients of the second group – Essentiale N, 39 patients of the third group – 5 % ethanol.

Results. It was found that intrasurgical administration of Hepasol-Neo decreased the risk of fat globulemia as compared with 5 % ethanol. Essentiale N and 5 % ethanol demonstrate significantly lower efficiency of prevention of fat globulemia in early period after surgery as compared with Hepasol-Neo.

Conclusion. Intrasurgical use of Hepasol-Neo decreased the risk of fat globulemia during the intervention and after it (without recurrent administration). It means the prolonged preventive effect.

Key words: fat globulemia; total hip joint replacement; Hepasol-Neo.

Information about authors:

Lebed M.L., MD, PhD, leading researcher, anesthesiologist-intensivist, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia.

Bocharova S.N., MD, PhD, professor, leading researcher of scientific and clinical department of anesthesiology and critical care medicine, Irkutsk Scientific Center of Surgery and Traumatology, assistant of chair of anesthesiology and critical care medicine, Irkutsk State Medical University, Irkutsk, Russia.

Golub I.E., MD, PhD, professor, chief of chair of anesthesiology and critical care medicine, Irkutsk State Medical University, Irkutsk, Russia.

Kirpichenko M.G., candidate of medical science, anesthesiologist-intensivist, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia.

Karmanova M.M., anesthesiologist-intensivist, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia.

Address for correspondence:

Bocharov S.N., Bortsov Revolyutsii St., 1, Irkutsk, Russia, 664003

Tel: +7 (3952) 29-03-68

Е-mail: bocharov@irk.ru

References:

1. Kosova E, Bergmark B, Piazza G. Fat embolism syndrome. Circulation. 2015; 131 (3): 317-320.

2. Lin KY, Wang KC, Chen YL et al. Favorable outcome of cerebral fat embolism syndrome with a Glasgow coma scale of 3: a case report and review of the literature. Indian J. Surg. 2015; 77 (1): 46-48.

3. Bederman SS, Bhandari M, McKee MD et al. Do corticosteroids reduce the risk of fat embolism syndrome in patients with long-bone fractures? A meta-analysis. Can. J. Surg. 2009; (52): 386-393.

4. Kornilov NV, Kustov VM. Fat embolism. Saint Petersburg: Morsar AV, 2001. 287 p. Russian

5. Kustov VM, Perfilyeva PE. Large joints replacement and fat embolism. In: Actual Issues of Orthopedics, Traumatology and Military Surgery: proceedings. Nizhny Novgorod, 1999. P. 30-31. Russian

6. Liepa ME. Fat globulinemia as a condition of fat embolism. Physiopathilogy and experimental therapy. 1973; (4): 32-36. Russian

7. Pashchuk AY, Fadeev PA. Diagnostics and treatment of fat embolism. Orthopedy, traumatology. 1991; (12): 41-43. Russian

8. Reshetnikov EA, Kyurdian LA, Ayrapetyan SA et al. To the early diagnostics, prevention and treatment of traumatic fat embolism. Orthopedy, traumatology and prosthetics. 1969; (10): 44-48. Russian

9. Bocharov SN, Plakhotina EN, Tvorogova SS. Prevention and treatment of experimental fat globulinemia. In: Proceedings of IX Russian National Congress “Man and his Health”. Saint Petersburg, 2004. p. 18-19. Russian

10. Tvorogova SS. Comparative assessment of the effectiveness of medicinal prevention and treatment of fat embolism. Cand. med. sci. Abstractdiss. Irkutsk, 2005. 22 p. Russian

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Interactions between central venous pressure and collapsIbility index of internal jugular vein in patients with trauma and blood loss

Nigmatullina A.R., Kasatkin A.A., Urakov A.L.

¹Izhevsk State Medical Academy,

²City Clinical Hospital No.9, Izhevsk, Russia

Noninvasive assessment of volemic status in patients with trauma and blood loss prevents the complications associated with central venous catheterization.

Objective – to research the dependence between central venous pressure and the collapsibility index of the internal jugular vein in patients with trauma.

Materials and methods. The study included 30 adult men and women with spontaneous breathing. The age of the patients was from 18 to 74. The ultrasound examination of the veins was performed using the apparatus ALPINIONE-CUBE 9 (South Korea) and the linear sensor 5-14 MHz. CVP was measured with the direct approach after placement of the catheter into the central vein.

Results. The group 1 (n = 13) showed CVP ≤ 4 cm H₂O and the collapsibility index was 60.5 ± 23.6 % (M ± SD), the group 2 (n = 17) – CVP ≥ 5 cm H₂O and the collapsibility index – 29.3 ± 21.7 %.

Conclusion. The value of central venous pressure in patients with trauma and blood loss depends on the collapsibility index of the internal jugular vein. Hypovolemia can be predicted only with the collapsibility index of the internal jugular vein more than 60 %.

Key words: ultrasound; blood loss; volemic status; monitoring.

Information about authors:

Nigmatullina A.R., postgraduate, chair of general and clinical pharmacology, Izhevsk State Medical Academy, anesthesiologist-intensivist, City Clinical Hospital No.9, Izhevsk, Russia.

Kasatkin A.A., candidate of medical science, head of department of anesthesiology and intensive care, City Clinical Hospital No.9, assistant of chair of general and clinical pharmacology, Izhevsk State Medical Academy, Izhevsk, Russia.

Urakov A.L., MD, PhD, professor, head of chair of general and clinical pharmacology, Izhevsk State Medical Academy, Izhevsk, Russia.

Address for correspondence:

Nigmatullina A.R., Ilfata Zakharova St., 9-27, Izhevsk, Russia, 426072

Tel: +7 (912) 011-14-35

Е-mail: rtan80@mail.ru

References:

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2. Agadzhanyan VV, Ustyantseva IM. Scientific-practical conception of polytrauma management. Polytrauma. 2013; 2 : 5-10. Russian

3. Urakov AL, Urakova NA, Kasatkin AA. Thermal imaging improves the accuracy of hemorrhagic shock diagnostics: the concept and practical recommendations. LAP Lambert Academic Publishing, 2016. P. 60.

4. Guerin L, Monnet X, Teboul JL. Prediction of fluid responsiveness: an update. Ann Intensive Care. 2016; 6 (1): 111.

5. Kasatkin AA, Urakov AL, Shchegolev AV, Nigmatullina AR. Internal jugular vein cannulation without the risk of double wall punctures. J Emerg Trauma Shock. 2016; 9: 157.

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7. Stawicki SP, Adkins EJ, Eiferman DS, Evans DC, Ali NA, Njoku C et al. Prospective evaluation of intravascular volume status in critically ill patients: does inferior vena cava collapsibility correlate with central venous pressure? J Trauma Acute Care Surg. 2014; 76 (4): 956-963.

8. Bauman Z, Coba V, Gassner M, Amponsah D, Gallien J, Blyden D et al. Inferior vena cava collapsibility loses correlation with internal jugular vein collapsibility during increased thoracic or intra-abdominal pressure. J Ultrasound. 2015; 18: 343–348.

9. Urakov AL, Kasatkin AA, Nigmatullina AR. The dynamics of changing internal jugular veins diameter based on increasing head elevation angle. Indian J Crit Care Med. 2015; 19: 610-612.

10. Kent A, Patil P, Davila V, Bailey JK, Jones C, Evans DC, et al. Sonographic evaluation of intravascular volume status: can internal jugular or femoral vein collapsibility be used in the absence of IVC visualization? Ann Thorac Med. 2015; 10: 44‑49.

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12. Agadzhanyan VV, Kravtsov SA, Shatalin AV, Levchenko TV. Hospital mortality in polytrauma and main directions for its decrease. Polytrauma. 2015; 1: 6-15. Russian

13. Unluer EE, Kara PH. Ultrasonography of jugular vein as a marker of hypovolemia in healthy volunteers. Am J Emerg Med. 2013; 31 (1): 173-177.

14. Akill NB, Cander B, Dundar ZD, Koylu R. A new parameter for the diagnosis of hemorrhagic shock: jugular index. J Crit Care. 2012; 27 (5): 530.e13-8.

Siva B, Hunt A, Boudville N. The sensitivity and specificity of ultrasound estimation of central venous pressure using the internal jugular vein. J Crit Care. 2012; 27(3): 315. e7-11.