Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
-
Acta Chir Orthop Traumatol Cech · May 1991
[Sequelae of injuries of the thoracolumbar spine and indications for surgery].
Inadequate treatment of a fresh injury of the thoracolumbar spine of failure or surgical treatment may lead to substantial restriction of the physical activity of the patient. This is due to posttraumatic kyphosis, possibly its progression, instability, painfulness and a persisting or progressing neurological finding. Forty-eight patients with unstable fracture of the thoracolumbar spine were, except one operated patient, treated originally by conservative methods, 15 of them were moreover subjected to isolated laminectomy. ⋯ The authors indicated surgery in 18 patients (37%) on account of pain, in 14 (29%) on account of instability, in 12 (25%) on account of progressing kyphosis and in 4 (8%) on account of an increasing nervous deficit. They included 26 patients with persisting partial nervous affections in the group with instability and progressing kyphosis, as anterior compression of the dural sac was revealed and they indicated release of nervous structures as part of the surgical operation. In the remaining partial neurological lesions with a patient spinal canal decompression was not indicated.
-
Polytrauma (multitrauma) is a short verbal equivalent used for severely injured patients usually with associated injury (i.e. two or more severe injuries in at least two areas of the body), less often with a multiple injury (i.e. two or more severe injuries in one body area). An important condition for the use of the term polytrauma is the incidence of the traumatic shock and/or hemorrhagic hypotensis and a serious endangering of one or more vital functions of the organism. At least one out of two or more injuries or the sum total of all injuries endangers the life of the injured person with polytrauma. ⋯ Polytraumatism embraces the broad health care and general societal problem area relating to severe associated and multiple injuries (i.e. to polytrauma). The author presents the actual classification of polytraumas according to their severity into four, three or two groups. This classification is based on the principles of general quantification of the severity of the injury (from the viewpoint of individual injuries and at the same time from the viewpoint of all concurrent injuries) divided into five or six grades.
-
Acta Chir Orthop Traumatol Cech · Jun 1990
[Results of surgical treatment of dislocation fractures of the ankle joint].
The authors have made evaluation of the surgical treatment of luxation fractures of the ankle in the period 1979-1987 in 105 patients (60 female, 45 male patients) in the age range from seventeen to eighty-one years, with the most frequent representation of the age group ranging from thirty-five to forty-five years. The group comprised 2,70 percent of fractures of type Weber A, 31.53 percent of fractures of type Weber B and 65.77 percent of fractures of type Weber C. 53 percent of patients were operated on the day of injury, 24.8 percent of patients were transferred with a delay from other clinics and in the rest of the patients the timely operation was contraindicated because of the poor local or general condition. ⋯ The main cause of failure was the osteoarthritis of the ankle joint found out in connection with the inaffestable factors (such as defects of cartilage, nature of the bone lesion, luxation of talus, age and sex of the patient) and affectable factors (infection, failure of osteosynthesis, pseudoarthrosis of medial malleolus, non-anatomical position in the area of tibiofibular syndesmosis). The incidence of these negative factors may be reduced by a timely operation, precise surgical strategy and technique and proper post-operative treatment.
-
The authors analyze briefly the criteria for the classification of multiple injuries and submit the definition they suggest: "Polytraumatism is a supraluminal injury of more than one bodily system which threatens the life and is associated with a serious traumatic response". The authors outline the minimal conditions which must be met by hospitals treating multiple injuries, which must operate continuously. Polytraumatism must be treated at surgical departments, only. ⋯ Depending on the urgency of these operations, it is possible to classify injuries into four grades, which are defined in more detail. The paper contains the authors' own group of multiple injuries formed by 47 casualties in 1984-1987. The lethality was 31.9% and is evidence of the serious character of polytraumatism.