To the question of establishing the severity of bodily injuries in open fractures of the lower limbs
Abstract
Summary: Currently existing "Rules for determining the severity of bodily injuries" do not correspond to the modern classification, the level of knowledge about clinical course and outcomes of open fractures of the lower extremities. Purpose - to conduct a comparative retrospective analysis of forensic medical examinations results to determine the severity of bodily injuries in victims with open and closed fractures of the lower extremities. Material and methods. Research material - 425 acts (170 primary, 185 commissions, 70 complex) forensic medical examinations of victims with fractures of the femur and / or tibia, performed in the Kharkiv Regional Bureau of Forensic Medicine for the period February - June 2018. Research methods - retrospective analysis, descriptive statistics. Results. It was found that both at the time of injury and in the event of its (injury) consequences in victims with a leading injury of the lower extremities, open fractures of the femur and tibia are assessed as severe bodily injuries without taking into account the nature of the fracture and the degree of damage to soft tissues (according to generally accepted classifications), although these data determine the features of treatment measures and the prognosis of trauma at the prehospital and hospital stages. Conclusions. Open fractures of long bones of the lower extremities of type I and II in clinical course, treatment approaches, a risk of complications differ significantly from open fractures of type III. Acute blood loss and hemorrhagic shock, which develop in fractures of long tubular bones as a result of damage of intraosseous, periosteal and muscle vessels, are characteristic of both open and closed fractures. The complicated consequences of open fractures of the lower extremities described in the literature are not life-threatening. The severe bodily injuries revealed as a result of this study were mainly the result of non-union periarticular and intra-articular fractures with persistent joint contracture. The above facts indicate the need to correct the "Rules for determining the severity of injuries" in the case of open fractures of long tubular bones and their differentiated use in fractures of varying complexity with varying degrees of soft tissue damage.
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References
Weber СD, Hildebrand F, Kobbe P, Lefering R, Sellei RM, Pape H-C. Epidemiology of open tibia fractures in a population-based database: update on current risk factors and clinical implications. Eur J Trauma Emerg Surg. 2019;45:445–453 https://doi.org/10.1007/s00068-018-0916-9
Gumbel D, Matthes G, Napp M, Lange J, Hinz P, Spitzmüller R, Ekkernkamp A. Current management of open fractures: results from an online survey. Arch Orthop Trauma Surg. 2016;136:1663–1672. https://doi.org/10.1007/s00402-016-2566-x
Hoff WS, Bonadies JA, Cachecho R, Dorlac WC. East Practice Management Guidelines Work Group: update to practice management guidelines for prophylactic antibiotic use in open fractures. J Trauma. 2011;70(3):751–754. https://doi.org/10.1097/TA.0b013e31820930e5
Metsemakers WJ, Reul M, Nijs S. The use of gentamicin-coated nails in complex open tibia fracture and revision cases: a retrospective analysis of a single centre case series and review of the literature. Injury. 2015;46(12):2433–2437. https://doi.org/10.1016/j.injury.2015.09.028
Court-Brown CM, Bugler KE, Clement ND, Duckworth AD, McQueen MM. The epidemiology of open fractures in adults. A 15-year review. Injury. 2012;43(6):891–897. https://doi.org/10.1016/j.injury.2011.12.007
Santos AL, Nitta CT, Boni G, Sanchez GT, Tamaoki MJS, Reis FB. Evaluation and comparison of open and closed tibia shaft fractures in a quaternary reference center. Acta Ortop Bras. 2018;26(3):194-7. DOI: https://doi.org/10.1590/1413-785220182603184073
Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Jt Surg Am. 1976;58(4):453–458.
Penn-Barwell JG, Bennett PM, Fries CA, Kendrew JM, Mid- winter MJ, Rickard RF. Severe open tibial fractures in com- bat trauma: management and preliminary outcomes. Bone Jt J. 2013;95-b(1):101–105.
Papakostidis C, Kanakaris NK, Pretel J, Faour O, Morell DJ, Giannoudis PV. Prevalence of complications of open tibial shaft fractures stratified as per the Gustilo–Anderson classification. Injury. 2011;42(12):1408–1415.
Connelly CL, Bucknall V, Jenkins PJ, Court-Brown CM, McQueen MM, Biant LC. Outcome at 12 to 22 years of 1502 tibial shaft fractures. Bone Jt J. 2014;96-b(10):1370–7. https:// doi.org/10.1302/0301-620x.96b10.32914.
Wordsworth M, Lawton G, Nathwani D, Pearse M, Naique S, Dodds A, Donaldson H et al. Improving the care of patients with severe open fractures of the tibia: the effect of the introduction of Major Trauma Networks and national guidelines. Bone Jt J. 2016;98-b(3):420–424.
Mundy LR, Grier AJ, Weissler EH, Carty MJ, Pusic AL, Hollenbeck ST, Gage MJ. Patient-reported Outcome Instruments in Lower Extremity Trauma: A Systematic Review of the Literature Plast Reconstr Surg Glob Open 2019;7:e2218. Published online 3 May 2019; www.PRSGlobalOpen.com. https://doi.org/10.1097/ GOX.0000000000002218.
Djahangiri A, Garofalo R, Chevalley F, Leyvraz P-F, Wettstein M, Borens O, Schizas C et al. Closed and Open Grade I and II Tibial Shaft Fractures Treated by Reamed Intramedullary Nailing. Med Princ Pract 2006;15:293–298 https://doi.org/10.1159/000092993
Briel M, Sprague S, Heels-Ansde D, Guyatt G, Bhandari M, Blackhouse G, Sanders D et al. Economic Evaluation of Reamed versus Unreamed Intramedullary Nailing in Patients with Closed and Open Tibial Fractures: Results from the Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT). Value in Health. 2011; 14(4):450-457. https://doi.org/10.1016/j.jval.2010.10.034.
Rules of forensic determination of the severity of bodily injuries. Approved by the order of the Ministry of Health of Ukraine of January 17, 1995 No 6. (Ukrainian)
Global status report on road safety 2018. Geneva: World Health Organization; 2018. Licence: CC BY- NC-SA 3.0 IGO. 403 р.
Grigorieva NV, Vlasenko RO. Epidemiology and risk factors for lower extremity fractures (literature review). Pain, Joints, Spine. 2017; 7(3):127-138. https://doi.org/10.22141/2224-1507.7.3.2017.116868 (Ukrainian)
Elniel AR, Giannoudis PV. Open fractures of the lower extremity: current management and clinical outcomes. EFORT Open Rev 2018;3:316-325. https://doi.org/10.1302/2058-5241.3.170072
Larsen P, Elsoe R, Hansen SH, et al. Incidence and epidemiology of tibial shaft fractures. Injury 2015;46:746-50. https://doi.org/10.1016/j.injury.2014.12.027
Jenkins PJ, Keating JF, Simpson AH. Fractures of the tibial shaft. Surgery 2010;28:489-93.
Kursov SV, Nikonov VV, Skoroplet SN. Blood loss. Emergency medicine. 2019;1(96):7-21. https://doi.org/10.22141/2224-0586.1.96.2019.158741. (Russian)
Zelle BA, Boni G. Safe surgical technique: intramedullary nail fixation of tibial shaft fractures. Patient Saf Surg 2015;9:40. https://doi.org/10.1186/s13037-015-0086-1
Ryan SP, Boulton CL, O’Toole RV. Open Diaphyseal Tibia Fractures. In: Ed. by: Sethi M, Obremskey W, Jahangir A. Orthopedic Traumatology. Cham.: Springer; 2018. Р. 287-302 https://doi.org/10.1007/978-3-319-73392-0_23
Santolini E, West R, Giannoudis PV. Risk factors for long bone fracture non- union: a stratification approach based on the level of the existing scientific evidence. Injury 2015;46(suppl 8):S8-S19. https://doi.org/10.1016/S0020-1383(15)30049-8
Calori GM, Albisetti W, Agus A, Iori S, Tagliabue L. Risk factors contributing to fracture non-unions. Injury 2007;38(suppl 2):S11-S18. https://doi.org/10.1016/S0020-1383(07)80004-0
Goh EL, Chidambaram S, Ma D. Complex regional pain syndrome: a recent update. Burns Trauma 2017;5:2. https://doi.org/10.1186/s41038-016-0066-4
Cannada lK, Melton DH, Deren ME, Hayda RA, Harvey EJ. Dealing with catastrophic outcomes and amputations in the mangled limb. J Orthop Trauma 2015;29(suppl 12):S39-S42. https://doi.org/10.1097/BOT.0000000000000468