Original researches

relationship between extended INFLAMMATORY parameters of hematologic analysis (NEUT-RI, NEUT-GI, RE-LYMP, AS-LYMP) with risk of infection in polytrauma

Ustyantseva I.M., Kulagina E.A., Aliev A.R., Agadzhanyan V.V.

Ustyantseva I.M., Kulagina E.A., Aliev A.R., Agadzhanyan V.V.

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

In our recent study, we showed a possibility for using the new diagnostic extended inflammatory parameters of hematologic analysis (activated neutrophils and lymphocytes) for diagnosis of septic complications in critically ill patients [11].

Objective – to estimate the clinical and predictive value of levels of extended inflammatory parameters of hematologic analysis (activated neutrophils and lymphocytes) in development of infection in patients with polytrauma.

Materials and methods. A prospective nested case-control study was conducted. 40 patients with polytrauma were examined in clinical conditions. They were admitted to the clinic within two hours after trauma within the period from January 2018 to March 2019.

The inclusion criteria were the age of 18-65, severe associated or multiple injuries, ISS (Injury Severity Score 16]) ≥ 30, absent lethal outcomes within 21 days after trauma. By the end of the follow-up (the day 21), all patients were distributed into two groups. The main group included all cases of infection (infection+) (n = 22; pneumonia, endobronchitis, purulent wounds, osteomyelitis, acute urethritis and others). The control group included all cases of microbial culture growing (infection -) (n = 18; acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation, fat embolism and others). The study results were compared in the patients of the main group (infection +, n = 22) and of the control group (infection -, n = 18).

SOFA was used for clinical estimation of patients and organ dysfunction. Glasgow Coma Scale was used for assessment of disordered consciousness. The signs of sepsis were identified in compliance with Sepsis-1 [12] and Sepsis-3 criteria [13].

The duration of stay in the intensive care unit (ICU) and in the clinic was estimated with consideration of number of artificial lung ventilation (ALV) days.

The main parameters were estimated including calculation of leukocytes, absolute and relative count of neutrophils, immature granulocytes (IG), as well as extended inflammatory parameters (NEUT-GI – neutrophil granularity intensity; NEUT-RI – neutrophil reactivity intensity; RE-LYMP – calculation of reactive lymphocytes; AS-LYMP – antibody synthesis lymphocytes) with the hematologic analyzer Sysmex XN-1000 (Sysmex Co., Japan) on the days 3 and 21 after admission to ICU.

The blood serum samples were estimated for apolipoprotein B (ApoB) with use of the analytic module platform Cobas 6000SWA (Switzerland). The serum levels of interleukins 6, 2R (IL-6, IL-2R) were measured with the immunochemiluminiscent analyzer IMMULITE ONE (USA) with the reagents (DPC, USA). The venous blood levels of pH, pO₂, pCO₂, glucose and lactate were measured with the analyzer of critical states Roche Omni S (Germany).

IBM SPSS Statistics 21 (Statistical Product and Service Solutions – SPSS) was used for statistical analysis of the data.

Results. The mean age of the patients (SD) was 41 (16). Most patients were men (70 %), mainly with associated injuries (88 %). The patients with polytrauma demonstrated the high incidence of registered infections (55 %). The infection appeared approximately after 5.5 days from the injury moment (IQR, 3-9). 22 patients had 29 cultures within the diagnostically significant titer.

A significant relationship between NEUT-RI (p = 0.03), NEUT-GI (p = 0.02) and infection was found and was confirmed with subsequent microbiological studies. The intergroup difference in the mean values of NEUT-RI and NEUT-GI was approximately 10 FI and 10 SI correspondingly. The increase in NEUT-RI by 10 FI was associated with increasing probability of infection (relative risk 1.0; 95 % confidence interval 1.1-3.6). The absolute increase in NEUT-GI by 10 SI was associated with less significant increase in probability of infection (relative risk – 2.7; 95 % CI 1.1-6.6). Interleukin-6, ISS, crystalloids and blood transfusion were also associated with increasing probability of infection.

Conclusion. The received findings show that the early changes in NEUT-RI and NEUT-GI are associated with the risk of nosocomial infection, which is registered later. Moreover, the intensity of the increase in inflammatory mediators and functional activity of neutrophils (NEUT-RI and NEUT-GI) in the blood can determine the severity of condition of patients.

Key words: neutrophil reactivity intensity NEUT-RI; neutrophil granularity intensity NEUT-GI; infection risk.

Information about authors:

Ustyantseva I.M., doctor of biological sciences, professor, deputy chief physician of clinical laboratory diagnostics, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Kulagina E.A., physician of clinical laboratory diagnostics, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Aliev A.R., physician of clinical laboratory diagnostics, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Agadzhanyan V.V., MD, PhD, professor, chief physician, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Address for correspondence:

Ustyantseva I.M., 7th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509

Regional Clinical Center of Miners’ Health Protection

Tel: +7 (384-56) 2-38-88; 2-39-90; 9-55-13

E-mail: irmaust@gnkc.kuzbass.net

REFERENCES:

1. Agadzhanyan VV, Ustyantseva IM, Pronskikh AA, Kravtsov SA, Novokshonov AV, Agalaryan AKh, Milukov AYu, Shatalin AV. Polytrauma. An acute management and transportation. Novosibirsk : Science, 2008. 320 p. Russian

2. Agadzhanyan VV. Septic complications in polytrauma. Polytrauma. 2006; (1): 9-17. Russian

3. Bone RC. Immunologic dissonance: a continuing evolution in our understand­ing of the systemic inflammatory response syndrome and the multiple organ dysfunction syndrome. Crit. Care Med. 1996; 125(8): 680-687.

4. Vincent JL, Opal SM, Marshall JC, Tracey KJ. Sepsis definitions: time for change. Lancet. 2013; 381(9868): 774-775.

5. Simpson SQ. SIRS in the time of Sepsis-3. Chest. 2018; 153(1): 34-38.

6. Rudnov VA, Kulabukhov VV. Sepsis – 3: revised key positions, potential problems and further practical steps. Herald of Anesthesiology and Critical Care Medicine. 2016; 13(4): 4-11. Russian

7. Kaukonen KM, Bailey M, Pilcher D, Cooper DJ, Bellomo R. Systemic inflammatory response syndrome criteria in defining severe sepsis. N Engl J Med. 2015; 372(17): 1629–1638.

8. Ustyantseva IM, Khokhlova OI, Agadzhanyan VV. Blood lactate level as a predictor of mortality in patients with polytrauma. Polytrauma. 2016; (4): 53-58. Russian

9. Ustyantseva IM, Khokhlova OI, Petukhova OV, Zhevlakova YuA. Time course of lipopolysaccharide-binding protein and lactate of blood in patients with polytrauma. General Critical Care Medicine. 2014; 10(5): 18-26. Russian

10. Ustyantseva IM, Khokhlova OI, Petukhova OV, Zhevlakova YuA, Agalaryan AKh. Predictive significance of inflammatory markers, lipopolysaccharide-binding protein and lactate in development of sepsis in patients with polytrauma. Polytrauma. 2014; (3): 15-23. Russian

11. Ustyantseva IM, Khokhlova OI, Petukhova OV, Zhevlakova YuA. Predictive significance of apolipoproteins A1 and B (apoA1 and apoB) in development of sepsis in patients with polytrauma. Polytrauma. 2016; (4): 15-22. Russian

12. Ustyantseva IM, Khokhlova OI, Agadzhanyan VV. Innovative laboratory technologies in diagnosis of sepsis. Polytrauma. 2018; (1): 52-59. Russian

13. American college of chest physicians/Society of critical care medicine consensus conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992; 20(6): 864-874.

14. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8): 801-810.

15. Halbgebauer R, Schmidt CQ, Karsten CM, Ignatius A, Huber-Lang M. Janus face of complement-driven neutrophil activation during sepsis. Semin Immunol. 2018; Feb 14. pii: S1044-5323(17)30117-3. doi: 10.1016/j.smim.2018.02.004.

16. Dinsdale RJ, Devi A, Hampson P, Wearn CM, Bamford AL, Hazeldine J, et al. Changes in novel haematological parameters following thermal injury: A prospective observational cohort study. Sci Rep. 2017; 7(1): 3211.

17. Larsen FF, Petersen JA. Novel biomarkers for sepsis: anarrative review. Eur J Intern Med. 2017; 45:46-50.

18. Park SH, Park CJ, Lee BR, Nam KS, Kim MJ, Han MY, et al. Sepsis affects most routine and cell population data (CPD) obtained using the Sysmex XN-2000 blood cell analyzer: neutrophil-related CPD NE-SFL and NE-WY provide useful information for detecting sepsis. Int J Lab Hematol. 2015; 37(2):190-198.

Clinical aspects of surgery

APPLICATION OF THE METHOD OF ULTRASOUND CAVITATIONS IN THE COMBINED TREATMENT OF TROPHIC ULCERS OF THE LOWER EXTREMITIES AGAINST THE BACKGROUND OF CHRONIC VENOUS INSUFFICIENCY

Soluyanov M.Yu., Shumkov O.A., Smagin M.A., Nimaev V.V.

Soluyanov M.Yu., Shumkov O.A., Smagin M.A., Nimaev V.V.

Research Institute of Clinical and Experimental Lymphology – Branch of Institute of Cytology and Genetics, Novosibirsk, Russia

The rate of trophic ulcers of the lower extremities in the developed countries is 4-5 patients per 1,000 of population. There is a persistent trend to increase in this group of patients. The actual task is searching for optimal techniques of treatment, with decrease in time of healing of ulcerous defect.

Objective – to estimate the clinical efficacy of ultrasound cavitations of wounds in the complex treatment of patients with trophic ulcers of the lower extremities and chronic venous insufficiency.

Materials and methods. A prospective, randomized clinical trial, consisting in the analysis of 90 patients suffering from chronic venous insufficiency of the 6th stage (CEAP classification), was conducted. The patients were divided into 2 groups. The comparison group (50 patients) received the standard surgical methods for venous reflux correction (combined subcutaneous phlebectomy, supplemented by Müller miniphlebectomy, as well as local surgical treatment of the wound defect). Fibrin plaque and soft tissue necrosis were removed using the standard surgical instruments: scissors, scalpel, and small curet. 40 patients of the main group, in addition to the combined subcutaneous phlebectomy and miniphlebectomy according to Müller, underwent a course of ultrasound cavitations of the ulcers with the Sonoca 300 (Zoring) device.

Results. It is shown that the ultrasound cavitations combined with treatment of trophic ulcers allows achieving a more rapid change of the phases of the wound process and, consequently, a decrease in the healing time of ulcers.

Conclusion. The combination of methods of surgical correction of venous reflux and local ultrasound cavitations effects on the ulcers improves the results of treatment of patients with trophic ulcers and chronic venous insufficiency.

Key words: ultrasound cavitations; trophic ulcers; phlebectomy; chronic venous insufficiency.

Information about authors:

Soluyanov M.Yu., candidate of medical science, surgeon, researcher of laboratory of surgical lymphology and lymphodetoxication, Research Institute of Clinical and Experimental Lymphology – Branch of Institute of Cytology and Genetics, Novosibirsk, Russia.

Shumkov OA, MD, PhD, chief of surgical unit of clinic, senior researcher of laboratory of surgical lymphology and lymphodetoxication, Research Institute of Clinical and Experimental Lymphology – Branch of Institute of Cytology and Genetics, Novosibirsk, Russia.

Smagin M.A., candidate of medical science, surgeon, junior researcher, laboratory of surgical lymphology and lymphodetoxication, Research Institute of Clinical and Experimental Lymphology – Branch of Institute of Cytology and Genetics, Novosibirsk, Russia.

Nimaev V.V., MD, PhD, surgeon, chief of laboratory of surgical lymphology and lymphodetoxication, Research Institute of Clinical and Experimental Lymphology – Branch of Institute of Cytology and Genetics, Novosibirsk, Russia.

Address for correspondence:

Soluyanov M.Yu., Dusi Kovalchuk St., 250-214, Novosibirsk, Russia, 630082

Tel: +7 (913) 952-65-29

E-mail: msoluyanov@mail.ru

REFERENCES:

1. Adam D, Naik J, Hartshorne T, Bello M, London NJ.The diagnosis and management of 689 chronic leg ulcers in a single-visit assessment clinic. Eur J Vasc Endovasc Surg. 2003; 25(5): 462-468.

2. Shevchenko YuL, Stoyko YuM, Gudymovich VG, Ivanov AK. An integrated approach to the treatment of extensive trophic leg ulcers in a multidisciplinary hospital. Bulletin of Experimental and Clinical Surgery. 2014; (7): 221-227. Russian

3. Charles H, Corser R, Varrow S, Hart J. A non-adhesive foam dressing for exuding venous leg ulcers and pressure ulcers: six case studies. J Wound Care. 2004; 13(2): 58-62.

4. Katorkin CE, Zhukov AA, Kushnarchuk MYu. Combined treatment of vasotrophic ulcers in chronic venous insufficiency of the lower extremities. Surgery News. 2014; 22 (6): 701- 709. Russian

5. Katorkin S, Sizonenko Y, Nasyrov M. Photodynamic therapy in the treatment of trophic leg ulcers. Vasomed. 2015; 27: 82-84.

6. Popov OS, Ganiev FF, Khlopotov PYu. Combined surgical method for the treatment of venous trophic ulcers of the lower extremities. Creative Surgery and Oncology. 2011; (1): 74-77. Russian

7. Shevchenko YuL, Stoyko YuM, Gudymovich VG, Ivanov AK. An integrated approach to the treatment of extensive trophic ulcers of the legs in a multidisciplinary hospital. Bulletin of Experimental and Clinical surgery. 2014; 7(3): 221-227. Russian

8. Kokhan RS. Vacuum therapy as a component of the surgical treatment of patients with chronic venous insufficiency complicated by trophic ulcer. Journal of Grodno State Medical University. 2016; 1(53): 29-32. Russian

9. Rubanov LN, Yarets YuI, Dundarov ZA. Clinical and laboratory confirmation of the effectiveness of using ultrasound debridement of chronic wounds in the process of preparing patients for autodermoplasty. Surgery News. 2012; 20(5): 70-76. Russian

10. Soluyanov MYu, Shumkov OA, Smagin MA, Nimaev VV. The choice of the method of primary necrotomy in patients with trophic ulcers on the background of diabetic foot syndrome. Polytrauma. 2017; (3): 38-42. Russian

RESULTS OF KNEE JOINT PRESERVATION AFTER TRANSTIBIAL AMPUTATION OF LOWER LIMBS IN OCCLUSIVE ILIAC ARTERIAL LESIONS

Koval O.A., Batiskin S.A., Zoloev D.G

Koval O.A., Batiskin S.A., Zoloev D.G

Novokuznetsk Scientific and Practical Centre for Medical and Social Expertise and Rehabilitation of Disabled Persons,

Novokuznetsk, Russia

Selection of amputation level in iliac arterial occlusion is one of the complex challenges for the surgeon. All documents available today are advisory and non-regulatory.

Objective – to investigate the knee joint preservation and the mortality rate after transtibial amputations in presence of occlusive involvements of iliac arteries.

Materials and methods. The analysis of 573 cases of transtibial amputations due to involved iliac arteries was performed. The main group included 83 patients with occlusion of iliac arteries, the control group – 490 patients with stenotic involvement; all 573 patients underwent the primary transtibial amputations. The results were assessed for preservation of knee joint and mortality of the patients within 3-month and 5-year period of time.

Conclusion. The values of primary amputation at transtibial level, the rate of mortality and re-amputations at hip level did not statistically differ in early and long-term periods.

Key words: leg amputation; occlusion of iliac arteries; level of amputation; knee joint preservation.

Information about authors:

Koval O.A., candidate of medical science, head of vascular surgery department, cardiovascular surgeon, Novokuznetsk Scientific and Practical Centre for Medical and Social Expertise and Rehabilitation of Disabled Persons, Novokuznetsk, Russia.

Batiskin S.A., candidate of medical science, surgeon, Novokuznetsk Scientific and Practical Centre for Medical and Social Expertise and Rehabilitation of Disabled Persons, Novokuznetsk, Russia.

Zoloev D.G., candidate of medical science, cardiovascular surgeon, Novokuznetsk Scientific and Practical Centre for Medical and Social Expertise and Rehabilitation of Disabled Persons, Novokuznetsk, Russia.

Address for correspondence:

Koval O.A.

Malaya St., 7, Novokuznetsk, Kemerovo region, Russia, 654055

Novokuznetsk Scientific and Practical Centre for Medical and Social Expertise and Rehabilitation of Disabled Persons

Tel: +7 (3843) 37-14-14

E-mail: root@reabil-nk.ru

REFERENCES:

1. Zoloev GK. Obliterative arterial disease. Surgical treatment and rehabilitation of patients with limb loss. 2 ed., rev. and enl. M.: Litterra, 2015. 480 p. Russian

2. Vasilchenko EM, Zoloev GK, Korolev SG. Estimation of functional results of primary prosthetics after hip or leg amputation in patients with vascular diseases. Problems of medicosocial expertise and rehabilitation of persons suffered from industrial accidents or occupational diseases: materials of All-Russian methodological seminar. Treatment, medicosocial expertise and rehabilitation in orthopedics, neurosurgery and angiology: materials of All-Russian scientific practical conference, Novokuznetsk, 16-17 September 2008. Kemerovo. Meditsina I Prosveshchenie, 2008; 85-86. Russian

3. Rehabilitation of disabled persons with support and motion dysfunction / Sytin LV, Zoloev GK, Vasilchenko EM. (ed.). Novosibirsk, 2003. 384 p. Russian

4. Ebskov LB, Hindsø K, Holstein P. Level of amputation following failed arterial reconstruction compared to primary amputation - a meta-analysis. Eur. J. Vasc. Endovasc. Surg. 1999; 17 (1): 35-40.

5. Zoloev GK, Chechenin GI, Suzrikov VG, Lobykin FI, Panfilov SD, Belyaev MV. Analysis of activities of surgical departments in Novokuznetsk city in delivering care to patients with chronic lower limb ischemia // Medicine at the turn of the century: collected papers dedicated to the anniversary of the municipal clinical hospital No.2. Novokuznetsk, 1999. P. 36-38. Russian

6. Rozhkov AV, Tateosov GI, Novoselova AI, Gundarev AV, Yankovskiy VM. Results of amputations and prosthetics in obliterating diseases of the lower extremities. In: Prosthetics and prosthesis building: collected papers. Moscow: Central Research Institute for Prosthetics and Prosthesis Building (CRIPPB) 1986. 76; 6-11. Russian

7. Zoloev GK, Ivatsin NP, Litvinovskiy SV. Selection of the level and method of limb stump formation in patients with obliterative arterial disease. Surgery. 1998; (4): 36-38. Russian

Clinical aspects of traumatology and orthopedics 

TREATMENT OF TALUS INJURIES IN POLYTRAUMA

Bonadarenko A.V., Batrak Ya.Yu., Plotnikov I.A.

Bonadarenko A.V., Batrak Ya.Yu., Plotnikov I.A.

Altai State Medical University,

Regional Clinical Hospital of Emergency Medical Care, Barnaul, Russia

Fractures and dislocations of the talus present a rare and complex pathology. They are not rare in polytrauma. Due to the unique anatomy, the blood supply features and multiple complex articulations of the talus, the treatment of these injuries is a significant challenge.

Objective – to find out the incidence, the features of the talus injuries in polytrauma, the peculiarities of the treatment, and the use of modern methods of minimally invasive osteosynthesis.

Materials and methods. The article is based on the treatment of 175 patients with 182 talus injuries. The patients were included with the continuous method and were treated in Regional Clinical Hospital of Emergency Medical Care in 2000-2018. There were 145 men (82.9 %) and 30 women (17.1 %). The talus injuries were observed in polytrauma in 117 patients (66.9 %), single talus injuries – in 58 (33.1 %) patients.

Results and discussion. Talus injuries with polytrauma were identified 2 times more often than isolated ones. Of 124 injuries to the talus with polytrauma, the opened damages were observed in 21 cases, while 58 cases of isolated trauma included only one. The overall fatality rate for the talus injuries was 1.1 %, for polytrauma – 1.7 %. There were 51 somatic complications in 34 (19.4 %) patients. Of them, 46 complications were in 31 patients (17.7 %) with polytrauma, and 5 complications (8.6 %) in patients with single injuries to the talus. Patients with polytrauma had all somatic complications with ISS > 30. There were 22 local complications in 20 (11.4 %) patients. Transcutaneous MIO with screws (4 mm channel) did not cause any local complications.

Conclusion. The talus injuries in polytrauma appear as result of high-energy impacts and occur 2 times more often than isolated ones. Somatic complications in patients with polytrauma are found more frequently (17.7 %), than in single injuries (1.7 %). The incidence of local complications showed the highest rate in opened fractures (up to 50 %), in fracture of neck of the talus of type 3 (46.1 %), in full dislocation of the talus (33.3 %) and in subtalar dislocation (19.5 %). In cases of severe general condition of patients with polytrauma, the temporary technique was transarticular fixation with K-wire for ankle and subtalar joints. It is almost impossible to use other methods instead of fixation with the external fixing device due to characteristics of soft tissue injuries in patients with severe opened injuries to the talus in polytrauma. The results of the use of transcutaneous low invasive fixation with 4 mm screws for fractures of the body and the neck of the talus allow recommending this technique for wider use in patients with polytrauma.

Key words: talus; osteosynthesis; polytrauma; cannulated screws.

Information about authors:

Bondarenko A.V., MD, PhD, professor, chief of traumatology unit 2, Regional Clinical Hospital of Emergency Medical Care, Barnaul, Russia.

Batrak Ya.Yu., traumatologists-orthopedist, traumatology unit 2, Regional Clinical Hospital of Emergency Medical Care, Barnaul, Russia.

Plotnikov I.A., candidate of medical science, senior resident, traumatology unit 2, Regional Clinical Hospital of Emergency Medical Care, Barnaul, Russia.

Address for correspondence:

Batrak Ya.Yu., Isakova St., 183-121, Barnaul, Altai Territory, Russia, 656054

Tel: +7 (903) 957-33-22

E-mail: 11traky@mail.ru

REFERENCES:

1. Agadzhanyan VV, Pronskikh AA, Ustyantseva IM, Agalaryan AKh, Kravtsov SA, Krylov YuM, et al. Polytrauma. Novosibirsk : Nauka Publ., 2003. 494 p. Russian

2. Sokolov VA. Multiple and concomitant injuries. M.: GEOTAR-Media, 2006. 512 p. Russian

3. Bondarenko AV et al. Treatment of injuries to posterior part of the foot in polytrauma. Barnaul, 2017. 88 p. Russian

4. Ruedi TP, Buckley RE, Moran CG. AO Principles of fracture management. New York: Thieme, 2007. Vol. 1– 2. 947 p.

5. Nikitin NV. Diagnosis and treatment of foot injuries. K.: Phenix, 2005; 192 p. Нiкiтiн Н.В. Дiагностика та лiкування пошкоджень кiсток стопи. К.: Фенiкс, 2005. 192 с. Russian

6. Foot surgery. Edited by Ardashev IP. Kemerovo: Siberian publishing group, 2018. 215 p. Russian

7. Muller ME, Allgover M, Schneider R, Willinegger H. The manual for internal fixation: the technique recommended by AO group (Switzerland): translated into Russian, 3rd edition, revised and corrected. M.: Ad Merginem, 1996. 750 p. Russian

8. Talus fractures. Materials of the book by Schatzker J., Tile M. The rational of operative fracture care. Margo Anterior. 1999; 5: 3-7. Russian

9. Talus fractures. Materials of the book Schatzker J., Tile M. The rational of operative fracture care. Margo Anterior. 1999; 6:1-15. Russian

10. Campbell’s operative orthopaedics. 11^th ed. Edited by S.T.Canale, J.H.Beaty. Mosby Elsevier Philadelphia, Pensylvania, 2008. P. 4851 – 4870.

11. Baker SP, O'Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J. Trauma. 1974; 14(3): 187 – 196.

12. Sokolov VA. Damage control – the modern concept for treatment of patients with critical polytrauma. Priorov Herald of Traumatology and Orthopedics. 2005; 1: 81-84. Russian

13. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle hind-foot, mid-foot, hallux and lesser toes. Foot and Ankle Internat. 1994; 15(7): 349-353.

14. Mattis ER. Estimation of outcomes of fractures of locomotors system bones and their consequences: the guidelines. M., 1983. 11 p. Russian

15. Glants S. Medicobiological statistics: translated from English. M.: Practice, 1998. 459 p. Russian

CONVERSION OSTEOSYNTHESIS IN TREATMENT OF PATIENTS WITH LONG BONE FRACTURES: LITERATURE REVIEW AND EXPERIENCE

Zagorodniy N.V., Solod E.I., Alsmadi Ya.M., Lazarev A.F., Abdulkhabirov M.A., Ananyin D.A., Petrovskiy R.A., Dmitrov I.A.

Zagorodniy N.V., Solod E.I., Alsmadi Ya.M., Lazarev A.F., Abdulkhabirov M.A., Ananyin D.A., Petrovskiy R.A., Dmitrov I.A.

Traumatology and orthopedics department, Peoples' Friendship University of Russia,

Eramishchantsev City Clinical Hospital, Moscow, Russia

The incidence of polytrauma reaches 14–15 % according to the modern studies. Primary final internal fixation is sometimes impossible due to traumatic shock, severe condition of patients or risk of postsurgical complications. Damage control concept is used for this task. It consists in programmed multi-staged surgical management of higher priority injuries. During realization of such management, the prominent place is given to conversion osteosynthesis with replacement of staged external fixing devices to internal constructs.

Conversion osteosynthesis is used both for treatment of polytrauma and for opened fractures, compartment syndrome and extensive closed injuries to soft tissues in fractures.

Objective – to evaluate the results of conversion osteosynthesis in different clinical situations and to improve the treatment outcomes.

Materials and methods. This is retrospective study with 120 patients with long bone fractures treated in the multi-profile hospital. For improving the analysis, we divided the patients into two groups: the first group – 41 patients with long bone fractures and polytrauma, the second group – 64 patients with closed single unstable fragmented and multi-fragmented fractures of long bones with serious posttraumatic edema of soft tissues.

Results. The time intervals of conversion osteosynthesis were 3-11 days in the polytrauma group, resulting in prevention of traumatic shock at the first stage and exclusion of severe complications in the postsurgical period. The patients with closed single unstable fragmented fractures of long bones with serious posttraumatic edema received the osteosynthesis on the days 5-8 after trauma resulting in prevention of inflammatory complications in the postsurgical period.

Conclusion. The conducted study confirmed the appropriateness of conversion osteosynthesis in treatment of patients with long bone fractures. The use of replacement of external fixation of fragments to internal fixation (conversion) promoted the recovery of fractures, stabilization of fragments and improvement in results of treatment of patients with long bone fractures.

Key words: fractures; long bones; osteosynthesis; conversion; external fixing devices.

Information about authors:

Zagorodniy N.V., MD, PhD, professor, corresponding member of RAS, chief of traumatology and orthopedics department, Peoples' Friendship University of Russia, Moscow, Russia.

Solod E.I., MD, PhD, chief researcher of scientific and clinical department of trauma and its consequences in adults, Priorov National Medical Research Center of Traumatology and Orthopedics, professor of traumatology and orthopedics department of medical faculty, Peoples' Friendship University of Russia, Moscow, Russia.

Alsmadi Ya.M., traumatologists-orthopedist, postgraduate of traumatology and orthopedics department, Peoples' Friendship University of Russia, Moscow, Russia.

Lazarev A.F., MD, PhD, chief of traumatology unit 1, Priorov National Medical Research Center of Traumatology and Orthopedics, Moscow, Russia.

Abdulkhabirov M.A., docent of traumatology and orthopedics department, Peoples' Friendship University of Russia, Moscow, Russia.

Ananyin D.A., candidate of medical science, traumatologists-orthopedist, Eramishchantsev City Clinical Hospital, assistant of traumatology and orthopedics department, Peoples' Friendship University of Russia, Moscow, Russia.

Petrovskiy R.A., traumatologists-orthopedist, clinical resident of traumatology and orthopedics department, Peoples' Friendship University of Russia, Moscow, Russia.

Dmitrov I.A., clinical resident of traumatology and orthopedics department, Peoples' Friendship University of Russia, Moscow, Russia.

Address for correspondence:

Yalsmadi Ya.M., Miklukho-Maklaya St., 17-561, Moscow, Russia, 117198

Tel: +7 (929) 620-40-83

E-mail: yaseenalsmadi@gmail.com

REFERENCES:

1. Yamkovoy AD. Osteosynthesis of fractures of long bones with nails. Abstracts of candidate of medical science. 14.01.15. M., 2017; 3-4. Russian

2. Khominets VV, Belenkiy IG, Kutyanov DI, Pechkurov AL. Management of treatment of fractures of long bones of extremities in patients with polytrauma. MEDLINE.RU. Russian Biomedical Journal. (Electronic journal). 2011; 12(2): 631-645. Access mode: http://medline.ru/public/art/tom12/art53.html Russian

3. Yamkovoy AD, Zorya VI. The use of intramedullary system fixation for treatment of shaft fractures of long bones 2014. Priorov Herald of Traumatology and Orthopedics. 2014; (3): 34-39. Russian

4. Pairon P, Ossendorf C, Kuhn S, Hofmann A, Rommens PM. Intramedullary nailing after external fixation of the femur and tibia: a review of advantages and limits. European Journal of Trauma and Emergency Surgery. 2015; 41(1): 25-38.

5. Kavalerskiy GM, Garkavi AV. Classifications of multiple injuries. Features of clinical course and diagnosis. Medicine of Critical Situations. Disaster Surgery. M.: Medical Information Agency, 2015; 165-367. Russian

6. Korzh NA, Dedukh NV. Reparative regeneration of bone: the modern view of the problem. Stages of regeneration. Orthopedics, Traumatology and Prosthetics. 2006; (1): 77-84. Russian

7. Backus JD, Furman BD, Swimmer T, Kent CL, McNulty AL, Defrate L, et al. Cartilage viability and catabolism in the intact porcine knee following transarticular impact loading with and without articular fracture. J. Orthop. Res. 2011; 29(4): 501-510.

8. Kobbe P, Micansky F, Lichte P, Sellei RM, Pfeifer R, Dombroski D, et al. Increased morbidity and mortality after bilateral femoral shaft fractures: myth or reality in the era of damage control. Injury. 2013; 44(2): 221–225.

9. Patka P. Damage control and intramedullary nailing for long bone fractures in polytrauma patients. Injury. 2017; 48 (Suppl 1): S7-S9.

10. Monni T, Birkholtz FF, de Lange P, Snyckers CH. Conversion of external fixation to internal fixation in a non-acute, reconstructive setting: a case series. Strategies Trauma Limb Reconstr. 2013; 8(1): 25-30.

11. Harbacheuski R, Fragomen A, Rozbruch S. Does lengthening and then plating (LAP) shorten duration of external fixation? Clin Orthop Relat Res. 2012; 470(6): 1771–1781.

12. Matsubara H, Shirai T, Watanabe K, Nomura I, Tsuchiya H. Clinical outcomes of conversion surgery from an external fixator to an iodine-supported titanium alloy plate. Journal of Microbial & Biochemical Technology. 2013; 6(1): 49-53.

13. van Dongen TT, Idenburg FJ, Tan EC, Rasmussen TE, Hamming JF, Leenen LP, et al. Combat related vascular injuries: dutch experiences from a role 2 MTF in Afghanistan. Injury. 2016; 47(1): 94–98.

14. Kataoka Y, Minehara H, Kashimi F, Hanajima T, Yamaya T, Nishimaki H, et al. Treatment combining emergency surgery and intraoperative interventional radiology for severe trauma. Injury. 2016; 47(1): 59–63.

15. Boutefnouchet T, Gregg R, Tidman J, Isaac J, Doughty H. Emergency red cells first: rapid response or speed bump? The evolution of a massive transfusion protocol for trauma in a single UK centre. Injury. 2015; 46(9): 1772–1778.

16. Recknagel S, Bindl R, Wehner T, Göckelmann M, Wehrle E, Gebhard F, et al. Conversion from external fixator to intramedullary nail causes a second hit and impairs fracture healing in a severe trauma model. Journal of Orthopaedic Research. 2013; 31(3): 465-471.

17. Pairon P, Ossendorf C, Kuhn S, Hofmann A, Rommens PM. Intramedullary nailing after external fixation of the femur and tibia: a review of advantages and limits. European Journal of Trauma and Emergency Surgery. 2015; 41(1): 25-38.

18. Matsumura T, Takahashi T, Miyamoto O, Saito T, Kimura A, Takeshita K. Clinical outcome of conversion from external fixation to definitive internal fixation for open fracture of the lower limb. Journal of Orthopaedic Science. 2019; Feb 13. URL: https://www.sciencedirect.com/science/article/pii/S0949265819300429?via%3Dihub

19. Xue XH, Yan SG, Cai XZ, Shi MM, Lin T. Intramedullary nailing versus plating for extra-articular distal tibial metaphyseal fracture: a systematic review and meta-analysis. Injury. 2013; 45(4): 667–676.

20. Bertrand ML, Andrés-Cano P, Pascual-López FJ. Periarticular fractures of the knee in polytrauma patients. Open orthopaedics journal. 2015; 9: 332-346.

21. Bhandari M, Zlowodzki M, Tornetta P3rd, Schmidt A, Templeman DC. Intramedullary nailing following external fixation in femoral and tibial shaft fractures. J Orthop Trauma. 2005; 19(2): 140-144.

22. Nicholas B, Toth L, van Wessem K, Evans J, Enninghorst N, Balogh ZJ. Borderline femur fracture patients: early total care or damage control orthopaedics? ANZ J Surg. 2011; 81(3): 148-153.

23. Pape HC, Rixen D, Morley J, Husebye EE, Mueller M, Dumont C, et al. Impact of the method of initial stabilization for femoral shaft fractures in patients with multiple injuries at risk for complications (borderline patients). Annals of Surgery. 2007; 246(3): 491-499.

24. Traumatic disease and its complications. Edited by Seleznev SA. St. Petersburg. Polytekhnika, 2004. 414 p. Russian

25. Testa G, Aloj D, Ghirri A, Petruccelli E, Pavone V, Massé A, et al. Treatment of femoral shaft fractures with monoaxial external fixation in polytrauma patients. F1000Research. 2017; 6: 1333.

26. Samusenko DV, Karasev AG, Martel II, Shvedov VV, Boychuk SP. Ilizarov’s method in staged management of associated injury and multiple fractures. Polytrauma. 2014; (1): 44-49. Russian

27. Tishkov NV, Danilov DG, Ochirov IA. Purulent complications in treatment of fractures of lower extremities with use of transosseous fixation techniques. Acta Biomedica Scientifica. 2007; 4(56); 175-176. Russian

ASSESSMENT AND SIGNIFICANCE OF STATE OF THE CAPSULE IN SURGICAL TREATMENT OF CHRONIC INSTABILITY OF THE SHOULDER JOINT

Parshikov M.V., Uzhakhov I.M., Yarygin N.V., Guryev V.V., Teterskiy A.A., Perevedentseva A.M., Gneteckiy S.F., Govorov M.V.

Parshikov M.V., Uzhakhov I.M., Yarygin N.V., Guryev V.V., Teterskiy A.A., Perevedentseva A.M., Gneteckiy S.F., Govorov M.V.

Yevdokimov Moscow State University of Medicine and Dentistry,

Semashko Road Clinical Hospital at Lyublino station of Russian Railways,

Moscow, Russia

The analysis of literature on treatment of chronic instability of the shoulder joint shows that results of treatment are not always satisfactory, and the subject has been studied insufficiently. The volume of diagnostics does not include the actions directed to studying of condition of the capsule of the shoulder joint. In our opinion, the lack of information on condition can be one of the reasons of unsatisfactory results as it does not allow planning the actions directed to improvement of condition of the capsule of the shoulder joint in the preoperative period. In this connection, we made the decision to survey the joint capsule by means of ultrasonic diagnostics.

Objective – to estimate and define the dependence of condition of the capsule in surgical treatment of chronic instability of the shoulder joint.

Patients and methods. The retrospective analysis included 37 patients with chronic instability of the shoulder joint treated with various joint plasty techniques, without presurgical ultrasonic examination of the shoulder joint. Also the results of presurgical diagnostics with inclusion of ultrasonic sonography and treatment of 22 patients with such pathology of the upper extremity were analyzed.

Results. Some cases of chronic instability of the shoulder joint are related to thinning of its capsule. After diagnosis of the capsule thinning, we carried out its strengthening according to our original technique.

Conclusion. The high relevance of the problem of chronic instability of the shoulder joint is an incentive to further studying of the reasons of its emergence, and existence of the diagnosed thinning of the capsule is the indication to its strengthening.

Key words: dislocation; instability of the shoulder joint; ultrasonography; surgery; operative measure.

Information about authors:

Parshikov M.V., MD, PhD, professor of department of traumatology, orthopedics and disaster medicine, Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.

Uzhakhov I.M., traumatologists-orthopedist, Semashko Road Clinical Hospital at Lyublino station of Russian Railways, Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.

Yarygin N.V., MD, PhD, professor, corresponding member of RAS, chief of department of traumatology, orthopedics and disaster medicine, Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.

Guryev V.V., MD, PhD, professor of department of traumatology, orthopedics and disaster medicine, Yevdokimov Moscow State University of Medicine and Dentistry; chief of traumatology and orthopedics center, Semashko Road Clinical Hospital at Lyublino station of Russian Railways, Moscow, Russia.

Teterskiy A.A., traumatologists-orthopedist, Semashko Road Clinical Hospital at Lyublino station of Russian Railways, Moscow, Russia.

Perevedentseva A.M., physician of ultrasonic diagnosis, Semashko Road Clinical Hospital at Lyublino station of Russian Railways, Moscow, Russia.

Gnetetskiy S.F., MD, PhD, docent of department of traumatology, orthopedics and disaster medicine, Yevdokimov Moscow State University of Medicine and Dentistry, chief of orthopedics unit, Semashko Road Clinical Hospital at Lyublino station of Russian Railways, Moscow, Russia.

Govorov M.V., assistant of department of traumatology, orthopedics and disaster medicine, Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.

Address for correspondence:

Uzhakhov I.M., Stavropolskaya St., 23, building 1, Moscow, Russia, 109386

Tel: +7 (925) 860-41-06

E-mail: ibra_moscow@mail.ru

REFERENCES:

1. Kobzarev VV. The optimization of surgical treatment of patients with frontal-lower and lower dislocation of showlder. Cand. med. sci. abstracts diss. 14.01.15. Samara, 2018. 24 p. Russian

2. Monastirev VV. Surgical treatment of patients with chronic posttraumatic instability of the shoulder joint at scapula bone defect.  Cand. med. sci. abstracts diss. Novosibirsk, 2014. 24 p. Russian

3. Dokolin SYu. Surgical treatment of patients with anterior dislocation of the shoulder using arthroscopy. Cand. med. sci. abstracts diss. St. Petersburg, 2002. 151 p. Russian

4. Matveev RP, Aslanov VA. The analysis of results of treatment a shoulder primary traumatic dislocation. Traumatology and Orthopedics of Russia. 2011; 1(59): 96-100. Russian

5. Khasanshin M.M. Treatment of patients with post-traumatic anterior instability of the shoulder joint using arthroscopic techniques. Doctor. med. sci. abstracts diss. 14.01.15. Moscow, 2014 18 p. Russian

6. Goncharov EN. Shoulder instability treatment on a base of complex diagnostics. Cand. med. sci. abstracts diss. Moscow, 2014. 14.01.15. 21 p. Russian Loppini M, Delle Rose G, Borroni M, Morenghi E., Pitino D., Domínguez Zamora C, et al. Is the instability severity index score a valid tool for predicting failure after primary arthroscopic stabilization for anterior glenohumeral instability? Arthroscopy. : 2019; 35(2): 361-366.

7. Monastirev VV, Sorokovikov VA, Vasiliev VYu, Puseva ME, Tishkov NV. The results of surgical treatment of patients with chronic posttraumatic instability of the shoulder joint at scapula bone defect.  Acta Biomedica Scientifica. 2013; (2): 38-43. Russian

8. Pazdnikov RV, Tayzhelov AA, Goncharova LD. Ways of optimizing the anchor stabilization of the shoulder capsule during open and arthroscopic treatment of shoulder instability // Original Researches. 2016; 3: 12-16. Russian

9. Kartus C, Kartus J, Matis N, Forstner R, Resch H. Long-term independent evaluation after arthroscopic extra-articular Bankart repair with absorbable tacks. A clinical and radiographic study with a seven to ten-year follow-up. J Bone Joint Surg Am. 2007; 89(7): 1442 – 1448.

10. Monastyrev VV, Vasilyev VYu, Puseva ME, Tishkov NV. Historical outline on the treatment of patients with chronic posttraumatic instability of shoulder joint (review of literature). Acta Biomedica Scientifica. 2013; (1):173-179. Russian

11. Misamore GW, Facibene WA. Posterior capsulorrhaphy for the treatment of traumatic recurrent posterior subluxations of the shoulder in athletes. Journal of Shoulder and Elbow Surgery. 2000; 9 (5): 403-408.

12. Bailie DS, Ellenbecker TS. Severe chondrolysis after shoulder arthroscopy: a case series. Journal of Shoulder and Elbow Surgery. 2009; 18(5): 742-747.

13. Hovelius L, Sandström B, Saebö M. One hundred eighteen Bristow-Latarjet repairs for recurrent anterior dislocation of the shoulder prospectively followed for fifteen years: Study II: the evolution of dislocation arthropathy. Journal of Shoulder and Elbow Surgery. 2006; 15(3): 279-289.

14. Bailie DS, Ellenbecker TS. Severe chondrolysis after shoulder arthroscopy: a case series. Journal of Shoulder and Elbow Surgery. 2009; 18(5): 742-747.

15. Misamore GW, Facibene WA. Posterior capsulorrhaphy for the treatment of traumatic recurrent posterior subluxations of the shoulder in athletes. Journal of Shoulder and Elbow Surgery. 2000; 9(5): 403-408.

16. Eskin NA. Ultrasound diagnosis in traumatology and orthopedics. Moscow, 2009. P. 4-8. Russian

Clinical aspects of neuro-surgery

Analysis of lethal outcomes in patients with spine and spinal cord injury in acute period

Yakushin O.A., Agadzhanyan V.V., Novokshonov A.V.

Yakushin O.A., Agadzhanyan V.V., Novokshonov A.V.

Regional Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia,

Tsyvyan Novosibirsk Research Center of Traumatology and Orthopedics, Novosibirsk, Russia

Objective – to conduct the analysis of lethal outcomes of treatment of patients with spine and spinal cord injury in the acute period in conditions of a specialized neurosurgery center.

Materials and methods. The retrospective analysis of medical documentation included 306 patients with spine and spinal cord injury treated in neurosurgery units of Regional Clinical Center of Miners’ Health Protection in 2000-2017. The mean age of patients was 36.5 ± 12.9 (age interval from 13 to 72). The study included 195 (63.7 %) patients with single injuries to the spine and the spinal cord, and 111 (36.3 %) patients with polytrauma. The average Injury Severity Score (ISS) was 25.2 ± 12.8. The exclusion criterion was terminal state at admission.

Results. The probability of a lethal outcome in patients with spinal cord injuries was higher in the first day after the injury, in male patients with cervical spine injuries and clinical signs of complete disorder of spinal cord conductance, at the age older 41.

58 patients in acute period of spine and spinal cord injury died at the stage of hospital treatment. The total hospital mortality was 18.9 %. The postsurgical mortality was 17.1 %.

The main cause of lethal outcomes in early period of treatment of patients with complicated spinal injury was acute cardiovascular failure after pulmonary embolism in 18.9 % of cases. In 79.3 % of cases, the mortality was determined by multiple organ failure within 14 days at the background of increasing spinal cord edema, and within the late period at the background of secondary purulent septic complications.

Conclusion. The timely surgical care for patients with spine and spinal cord injury with use of microsurgical techniques and realization of early rehabilitation treatment decrease the general mortality in patients with complete disorder of spinal cord conductance by 26.9 %, with partial disorder of conductance – by 2.8 %.

Key words: mortality; spine injury; spinal cord injuries; spinal cord surgery.

Information about authors:

Yakushin O.A., candidate of medical science, traumatologists-orthopedist, neurosurgery unit No.2, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia; leading researcher of polytrauma department, Tsyvyan Novosibirsk Research Center of Traumatology and Orthopedics, Novosibirsk, Russia.

Agadzhanyan V.V., MD, PhD, professor, chief physician, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia; chief of polytrauma department, Tsyvyan Novosibirsk Research Center of Traumatology and Orthopedics, Novosibirsk, Russia.

Novokshonov A.V., MD, PhD, chief of neurosurgery unit No.2, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia; leading researcher of polytrauma department, Tsyvyan Novosibirsk Research Center of Traumatology and Orthopedics, Novosibirsk, Russia.

Address for correspondence:

Yakushin O.A., 7th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509

Tel: +7 (38456) 9-53-58, +7 (905) 075-53-73

E-mail: Yakushin-GNKC@rambler.ru

REFERENCES:

1. Dulaev AK, Khan ISh, Dulaeva NM. The causes of poor anatomic and functional results of treatment of patients with fractures of thoracic and lumbar spine. Spine Surgery. 2009; (2): 17-24. Russian

2. Volkov SG, Vereshchagin EI. Ideas on pathogenesis of traumatic spinal cord injury and possible ways of therapy: literature review. Spine Surgery. 2015; 12(2): 8-15. Russian

3. Shevchenko NN, Titov YuD, Dmitriev KN, Boryak AL. Spine and spinal cord injury – medical care at stages of medical evacuation. Traumatology, Orthopedics and Military Medicine. 2016; (1): 70-75. Russian

4. Neurosurgery. European manual: two volumes. Volume two. Edited by Lument HB et al. Translated from English by Gulyaev DA. M.: Izdatelstvo Panfilova; BINOM. Laboratoriya Znaniy, 2013. 699 p. Russian

5. Yugué I, Aono K, Shiba K, Ueta T, Maeda T, Mori E, et al. Analysis of the factors for severity of neurologic status in 216 patients with thoracolumbar and lumbar burst fractures. Spine. 2011; 36(19): 1563-1569.

6. Essentials of spinal cord injury: basic research to clinical practice / editors: M.G. Fehlings et al. New York ; Stuttgart: Thieme, 2013. [xiv], 658 p.

7. Morozov IN, Mlyavykh SG. Epidemiology of spine and spinal cord injury (review). Medical Almanac. 2011; 4(17): 157-159. Russian

8. Agadzhanyan VV, Pronskikh AA, Ustyantseva IM, Agalaryan AKh, Kravtsov SA, Krylov YuM et al. Polytrauma. Novosibirsk: Nauka, 2003; 494 p. Russian

9. Shchedrenok VV, Yakovenko IV, Moguchaya OV. Clinical and organizational aspects of associated traumatic brain injury. SpB: Publishing office by Russian Polenov Research Institute of Neurosurgery, 2010; 435 p. Russian

10. Dehghan N, de Mestral C, McKee MD, Schemitsch EH, Nathens A. Flail chest injuries: a review of outcomes and treatment practices from the National Trauma Data Bank. J Trauma Acute Care Surg. 2014; 76(2): 462-468.)

11. Kann SL, Churlyaev YuA. Intensive care of severe spine and spinal cord injury (literature review). Polytrauma. 2007; (2): 67-75. Russian

12. Sokolov VA. Damage Control – modern concept of treatment of patients with critical polytrauma. Priorov Herald of Traumatology and Orthopedics. 2005; (1): 81-84. Russian

13. Pape H.C. Damage-control orthopedic surgery in polytrauma: Influence on the clinical course and its pathogenetic background. In: European instructional lectures. European Federation of National Associations of Orthopaedics and Traumatology. Bentley G. (eds). Vol. 9. Berlin; Heidelberg: Springer, 2009. P. 67-74.

14. Neurosurgery: manual for doctors: two volumes. Edited by Dreval ON. Volume 2. Lectures, seminars, clinical discussions. M.: Litera, 2013. 864 p. Russian

Functional, instrumental and laboratory diagnostics

TIME COURSE OF C1-ESTERASE INHIBITOR AND ITS ROLE IN PREDICTION OF OUTCOME OF SEVERE TRAUMATIC BRAIN INJURY

Borshchikova T.I., Epifantseva N.N., Kan S.L., Nikiforova N.V.

Borshchikova T.I., Epifantseva N.N., Kan S.L., Nikiforova N.V.

Novokuznetsk Institute of Medical Extension Course – the branch of Russian Medical Academy of Continuous Professional Education, Novokuznetsk, Russia

Objective – to study the time course of the C1-esterase inhibitor and its role in prediction of the outcome of severe traumatic brain injury.

Methods. The study included 53 patients with severe traumatic brain injury (STBI). At admission, Glasgow Coma Scale was 6.9 ± 2, APACHE II – 19.7 ±  4.7. The mortality after STBI was 50.9 % (27). The serum venous blood levels of fibrinolysis inhibitors (C1-esterase inhibitor (C₁I), α₁-antitrypsin, α₂-antiplasmin, α₂-macroglobulin), C-reactive protein, and proteins of C3 and C4 components were estimated with immunoturbidimetric technique with the biochemical analyzer KONELAB-60i with testing systems Spinreact (Spain) and Labsystems (Finland) on the days 1, 4, 7, 14 and 21. The protein S100 levels were determined with the method of enzyme-linked immunosorbent assay with test systems CanAg (Austria). The coagulation parameters were estimated: spontaneous fibrinolytic activity with euglobulin method, activity of XII- kallikrein-dependent and streptokinase-induced fibrinolysis. Plasminogen reserve index was calculated. The activity of protein C and antithrombin-III was measured with tests Technology-Standard (Russia). The D-dimer was determined with the method of solid-phase immunofluorescent analysis (BioRad, USA) with test systems Technoclon (Austria). The level of soluble fibrin-monomer complexes was measured with the orthophenanthroline method (test systems Technology-Standard, Russia). The activity of contact factors (prekallikrein, high-molecular-weight kininogen, factors XII and XI of blood serum) was estimated with clotting technique with coagulometer ACL-7000 (Instrumentation Laboratory, USA) in 16 patients with STBI.

Results. Beginning from the first day of STBI, C₁I was actively consumed as result of microclotting, in the second week of the posttraumatic period – as result of inflammation in formation of secondary purulent and inflammatory complications. Early prediction of the outcome of STBI with 95 % probability is possible with use of the following values in the multiple regression analysis: C₁I, S100 protein, absolute number of lymphocytes and proteins of acute phase of inflammation (C-reactive protein and fibrinogen).

Conclusion. The high level of C₁I serum consumption in STBI is the early predictor of the poor outcome of the disease.

Key words: severe traumatic brain injury; C¹- esterase inhibitor.

Information about authors:

Borshchikova T.I., candidate of medical science, assistant of anesthesiology and critical care medicine department, Novokuznetsk Institute of Medical Extension Course – the branch of Russian Medical Academy of Continuous Professional Education, Novokuznetsk, Russia.

Epifantseva N.N., candidate of medical science, assistant of clinical laboratory diagnostics department, Novokuznetsk Institute of Medical Extension Course – the branch of Russian Medical Academy of Continuous Professional Education, Novokuznetsk, Russia.

Kan S.L., MD, PhD, docent, chief of anesthesiology and critical care medicine department, Novokuznetsk Institute of Medical Extension Course – the branch of Russian Medical Academy of Continuous Professional Education, Novokuznetsk, Russia.

Nikiforova N.V., MD, PhD, assistant of anesthesiology and critical care medicine department, Novokuznetsk Institute of Medical Extension Course – the branch of Russian Medical Academy of Continuous Professional Education, Novokuznetsk, Russia.

Address for correspondence:

Borshchikova T.I., Sechenova St., 26, Novokuznetsk, Kemerovo region, Russia, 654066, Novokuznetsk Perinatal Centre, anesthesiology and critical care medicine unit

Tel: +7 (3843) 324-951; +7 (905) 961-97-37
E-mail: tamara.borshchikova@mail.ru

REFERENCES:

1. Davis AE. Biological activities of C1 inhibitor. Mol. Immunol. 2008; 45 (16): 4057-4063.

2. Wagenaar-Bos IG, Hack CE. Structure and function of C1-inhibitor. Immunol Allergy Clin North Am. 2006; 26 (4): 615-632.

3. Hirose T, Ogura H, Takahashi H, Ojima M, Jinkoo K, Nakamura Y, et al. Serial change of C1-inhibitor in patients with sepsis: a prospective observational study. J Intensive Care. 2018; 6: 37.

4. Caliezi C, Wuillemin WA, Zeerleder S, Redondo M, et al. C1-esterase inhibitor: an anti-inflammatory agent and its potential use in the treatment of diseases other than hereditary angioedema. Pharmacol Rev. 2000; 52 (1): 91-112.

5. Li HH. Self-administered C1-esterase inhibitor concentrates for the management of hereditary angioedema: usability and patient acceptance. Patient Prefer Adherence. 2016; 10: 1727-1737.

6. Yarovaya GA, Neshkova AE. Kallikrein-kininovaya system. Past and present (for the 90th anniversary of the opening of the system). Bioorganic chemistry. 2015; 41 (3): 275 – 291. Russian

7. Singer M, Jones AM. Bench-to-bedside review: the role of C1-esterase inhibitor in sepsis and other critical illnesses. Crit Care. 2011; 15 (1): 203.

8. Lichterman LB. Classification of cranial trauma. Part II. Modern principles of classification of TBI. Judiciary medicine. 2015; 1 (3): 37-48. Russian

9. Dolgov VV, Shevchenko VV, Dolgov OP, Sharyshev AA, Bondar VA. Turbidimetry in laboratory practice. M.: Reafarm, 2007. 176 p. Russian

10. Jiang H, Wagner E, Zhang H, Frank MM. Complement 1 - inhibitor is a regulator of the alternative complement pathway. J Exp Med. 2001; 194 (11): 1609 - 1616.

11. Albert-Weissenberger C, Mencl S, Schuhmann MK, Salur I, Göb E, Langhauser F, et al. C1-Inhibitor protects from focal brain trauma in a cortical cryolesion mice model by reducingthrombo-inflammation. Front Cell Neurosci. 2014; 8: 269.

12. Zhang J, Jiang R, Liu L, Watkins T, Zhang F, Dong JF. Traumatic brain injury-associated coagulopathy. J Neurotrauma. 2012; 29 (17): 2597 - 2605.

13. Yepifantseva NN, Borshchikova TI, Churlyaev YuA, Ratkin IK, Yekimovskikh AV. Prognostics value of S100 protein, neuron-specific enolase, endothelin-1 in the acute period of severe brain injury. Emergency Medicine. 2013; 3 (50): 85-90. Russian

Case history

a clinical case of successful treatment of a patient with polytrauma and successful traumatic skin detachment in the left leg

Blazhenko A.N., Kurinny S.N., Mukhanov M.L., Blazhenko A.A., Afaunov A.A.

Blazhenko A.N., Kurinny S.N., Mukhanov M.L., Blazhenko A.A., Afaunov A.A.

Kuban State Medical University,

Krasnodar, Russia

Objective – to discuss the features of two-stage skin grafting by Krasovitov using vacuum compression to the area of the replanted skin autograft.

Materials and methods. A clinical case of the surgical treatment of patient K., born on October 27, 1985, was reported as a result of an accident that received polytrauma (AIS / NISS – 21 points) and an extensive traumatic detachment of the skin of the left leg (5 %). In the primary treatment hospital (level 2 trauma center), the primary surgical treatment of wounds to the face was conducted, as well as skin suturing and placement of the active tube drain.

Eight hours after trauma, he was transferred to Level 1 Trauma Center (Regional Clinical Hospital No.1, Krasnodar), where he was immediately subjected to a second surgical treatment of the wound of the left leg with cutting off of the detached skin flap, its treatment, preparation and fixation of the left lower extremity with use of external fixation device. 48 hours after stabilization, a staged, planned surgical treatment of the wound of the left leg was conducted. The wound revision did not show any signs of soft tissue necrosis. It allowed performing the skin plasty of soft tissue defects of the left leg according to Krasovitov with use of the prepared and preserved skin flap. In the end of the surgery, VAC-compression of skin autograft with negative pressure of 50 mm was carried out.

After 5 days, ligation was performed with assessment of the state of the transplanted skin, repeated VAC-compression for two days.

Results. As a result of the staged surgical treatment, it was possible to avoid necrosis of the rejected skin flap, the development of infectious complications, to restore the skin and to ensure optimal rehabilitation of the patient.

Conclusion. The clinical observation suggests that treatment of patients with polytrauma and extensive traumatic skin detachment should be carried out in level 1 trauma centers. It is necessary to transfer such patients in the first days after the injury, in order to avoid the development of infectious complications and necrosis of the rejected skin flap. VAC-compression of a full-thickness skin flap with Krasovitov’s technique with a negative pressure of 50 mmHg contributes to its better adaptation to the underlying soft tissues and acceptance. Kraosovitov’s two-stage skin grafting in patients with polytrauma allows stabilizing their condition, with minimal operational injury at the first stage, and performing the second stage in more favorable conditions of the patient’s stable condition.

Key words: polytrauma; traumatic skin detachment; skin grafting by Krasovitov; primary surgical treatment of a wound; repeated surgical treatment of a wound.

Information about authors:

Blazhenko A.N., MD, PhD, docent, professor of chair of orthopedics, traumatology and military field surgery, Kuban State Medical University, Krasnodar, Russia.

Kurinny S.N., chief of traumatology and orthopedics unit No.1, Research Institute – Ochapovskiy City Clinical Hospital No.1, Krasnodar, Russia.

Mukhanov M.L., assistant of chair of orthopedics, traumatology and military field surgery, Kuban State Medical University, Krasnodar, Russia.

Blazhenko A.A., candidate of medical science, traumatologists-orthopedist, traumatology and orthopedics unit No.1, Research Institute – Ochapovskiy City Clinical Hospital No.1, Krasnodar, Russia.

Afaunov A.A., student of 5th course of medical faculty, Kuban State Medical University, Krasnodar, Russia.

Address for correspondence:

Mukhanov M.L., Artyushkova St., 3-128, Krasnodar, Russia, 350016

Tel: +7 (961) 509-15-81

E-mail: pputinn@yandex.ru

REFERENCES:

1. Loktionov PV, Gudz YuV. Experience in the treatment of lower limb wounds with extensive traumatic detachment of the skin and subcutaneous tissue. Medico-Biological and Socio-Psychological Problems of Sotely in Emergency Situations. 2015; (1): 22-28. Russian

2. Kothe M, Lein T, Weber AT, Bonnaire F. Morel-Lavallee lesin. A grave soft tissue injury. Unfallchirurg. 2006; 109 (1): 82-86.

3. Kudsk KA, Sheldon GF, Walton RL. Degloving injuries of the extremities and torso. J. Trauma. 1981; 21 (10): 835-839.

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arteriovenous fistula as a complication after total knee JOINT replacement

Dmitrov I.A., Zakharyan N.G., Bezverkhiy S.V., Takiev A.T., Alekseeva O.S., Asmaldi Ya.M.I., Aliev R.N.

Dmitrov I.A., Zakharyan N.G., Bezverkhiy S.V., Takiev A.T., Alekseeva O.S., Alsmadi Ya.M.I., Aliev R.N.

Moscow City Clinical Hospital No.31,

Moscow, Russia

Total knee replacement is one of the most efficient surgical interventions providing the functional recovery of the extremity and removal of pain syndrome in patients suffering from degenerative and dystrophic changes of the knee joint. One of the rarest postsurgical complications is formation of arteriovenous fistula as result of an injury to branches of magistral vessels.

Objective – to review the causes of formation of arteriovenous fistula by the example of a clinical case.

Materials and methods. According to the literature data, the precise causes of arteriovenous fistula are unknown at the present time. We presented the analysis of the world literature relating to the problem of formation of arteriovenous fistula in patients after total knee joint replacement.

Results. In our case, considering the anamnesis of the patient’s disease (falling from the level of her own height) and absent data on intrasurgical or postsurgical complications within 9 months, one can suppose that the possible cause of formation of arteriovenous fistula between the branch of the popliteal artery and the popliteal vein is a traumatic impaction.

Conclusion. Formation of arteriovenous fistula is a very rare complication after total knee joint replacement. During differential diagnosis one should consider the possibility of this complication.

Key words: arteriovenous fistula; total knee joint replacement; tissue balloon expander; revision prosthetics.

Information about authors:

Dmitrov I.A., clinical resident of traumatology and orthopedics department of Peoples' Friendship University of Russia, orthopedics unit, Moscow City Clinical Hospital No.31, Moscow, Russia.

Zakharyan N.G., candidate of medical science, traumatologists-orthopedist, chief of orthopedics unit, Moscow City Clinical Hospital No.31, Moscow, Russia.

Bezverkhiy S.V., candidate of medical science, traumatologists-orthopedist, clinical and diagnostic unit, Moscow City Clinical Hospital No.31, Moscow, Russia.

Takiev A.T., candidate of medical science, traumatologists-orthopedist, orthopedics unit, Moscow City Clinical Hospital No.31, Moscow, Russia.

Alekseeva O.S., candidate of medical science, traumatologists-orthopedist, Moscow City Clinical Hospital No.31, Moscow, Russia.

Alsmadi Ya.M.I., traumatologists-orthopedist, Moscow City Clinical Hospital No.31, clinical resident of traumatology and orthopedics department, Peoples' Friendship University of Russia, Moscow, Russia.

Aliev R.N., candidate of medical science, docent of traumatology and orthopedics department, Peoples' Friendship University of Russia; traumatologists-orthopedist, orthopedics unit, Moscow City Clinical Hospital No.31, Moscow, Russia.

Address for correspondence:

Dmitrov I.A., Leninskiy prospect, 79-200, Moscow, Russia, 119261

Tel: +7 (909) 166-25-41

E-mail: dr.dmitrov@gmail.com

REFERENCES:

1. Khan M, Osman K, Green G, Haddad FS. The epidemiology of failure in total knee arthroplasty. Bone Joint J 2016; 98-B (1 Suppl A):105–112.

2. National Joint Registry for England, Wales and Northern Ireland. 11th annual report, 2014. http://www.njrreports.org.uk/Portals/0/PDFdownloads/. (date last accessed 25 June 2015).

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8. Shin YS, Hwang YG, Savale AP, Han SB. Popliteal artery pseudoaneurysm following primary total knee arthroplasty. Knee Surg Relat Res. 2014; 26(2):117–120. doi:10.5792/ksrr.2014.26.2.117 .

9. Dua A, Zepeda R, Hernanez FC, Igbadumhe AA, Desai SS. The national incidence of iatrogenic popliteal artery injury during total knee replacement. Vascular. 2015; 23(5): 455–458. doi:10.1177/1708538114552464

10. Thomas R, Agarwal M, Lovell M, Welch M. An unusual presentation of a popliteal arteriovenous fistula after primary total knee arthroplasty. J Arthroplasty. 2008; 23(6):945–948. doi: 10.1016/j.arth.2007.06.016. 

11. Ceallaigh PO, Hogan N, McLaughlin R, Bouchier-Hayes D. Popliteal arteriovenous fistula post total knee replacement. EJVES Extra. 2004; 7: 33–35. doi: 10.1016/j.ejvsextra.2004.01.001

12. Kane I, Post Z, Ong A, Orozco F. Arteriovenous fistula formation after intra-articular injection following total joint arthroplasty. Orthopedics. 2016; 39: 976-979. doi:10.3928/01477447-20160526-05.

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14. Kovacs F, Pollock JG, DeNunzio M. Endovascular stent graft repair of iatrogenic popliteal artery injuries: a report of 2 cases. Vasc Endovascular Surg. 2012; 46(3): 269–272. doi:10.1177/1538574411434163

15. Da Silva MS, Sobel MSurgeons of the Southern Association of Vascular Surgery. Popliteal vascular injury during total knee arthroplasty. J Surg Res. 2003; 109(2):170–174. doi:10.1016/S0022-4804(02)00088-4

16. Shin YS, Hwang YG, Savale AP, Han SB. Popliteal artery pseudoaneurysm following primary total knee arthroplasty. Knee Surg Relat Res. 2014; 26(2):117–120. doi:10.5792/ksrr.2014.26.2.117 

17. Sandoval E, Ortega FJ, Garcia-Rayo MR, Resines C. Popliteal pseudoaneurysm after total knee arthroplasty secondary to intraoperative arterial injury with a surgical pin: review of the literature. J Arthroplasty. 2008; 23(8):1239. doi:10.1016/j.arth.2007.08.022

Reviews

MODERN POSSIBILITIES OF THE USE OF STROMAL-VASCULAR FRACTION OF ADIPOSE TISSUE IN TRAUMATOLOGY AND ORTHOPEDICS

Miromanov A.M., Miromanov M.M., Miromanova N.A.

Miromanov A.M., Miromanov M.M., Miromanova N.A.

Chita State Medical Academy,

Chita, Russia

The review analyzes the literature data on the use of adipose tissue stem cells in medical practice, presents the sources and methods for its isolation, characterization of the composition, immune phenotype and cell differentiation directions.

Objective – to reveal the possibilities of the mesenchymal multipotent adipose tissue cells, to compare their osteogenic and chondrogenic differentiation with the stem cells of the bone marrow, and also to outline the boundaries of their use in traumatology and orthopedics.

Materials and methods. The analysis of modern domestic and foreign literature on the isolation, breeding and clinical use of multipotent mesenchymal stem cells of adipose tissue in medical practice has been carried out.

Results. In the recent years, numerous experimental models have been developed for the use of stem cells in the regeneration of organs and tissues. Most studies confirm the lower osteogenic capacity of adipose tissue stem cells, but many of the mechanisms of their osteogenic potential have yet to be clarified. Unfortunately, many studies compare only two stem cells in a normal, healthy environment, but there are many different scenarios for the repair of bone, cartilage and other tissues in the clinical situation. As for chondrogenic differentiation, the potential of stem cells is almost as good as the potential of bone marrow stem cells.

Conclusion. Stem cells manifest their regenerative potential, both by direct differentiation and indirectly, by influencing the “cell niche”. Studies of the ability of adipose tissue stem cells to differentiate in vivo did not show convincing results, most of them due to the lack of standards for working with this material. The main task, of course, is the creation of standardized protocols for obtaining, selecting and differentiating this cell culture, which will allow this technology to be applied in traumatology and orthopedics in the treatment of many pathological processes.

Key words: adipose tissue; stromal vascular fraction; stem cells; differentiation; traumatology and orthopedics.

Information about authors:

Miromanov A.M., MD, PhD, docent, chief of traumatology and orthopedics department, Chita State Medical Academy, chief traumatologists-orthopedist of Health Ministry of Zabaykalsky Krai, Chita, Russia.

Miromanov M.M., resident of traumatology and orthopedics department, Chita State Medical Academy, Chita, Russia.

Miromanova N.A., MD, PhD, docent, chief of department of pediatric infections, Chita State Medical Academy, Chita, Russia.

Address for correspondence:

Miromanov A.M., Gorkogo St., 39a, Chita, 672090, Russia

Chita State Medical Academy, traumatology and orthopedics department

Tel: +7 (924) 386-18-16

Е-mail: miromanov_a@mail.ru

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