THE IMPACT OF CHOICE OF TREATMENT TACTICS IN POLYTRAUMA PATIENTS WITH MULTIPLE LONG BONE FRACTURES OF LOWER EXTREMITIES ON THE COMPLICATIONS DEVELOPMENT

Abstract

Introduction. The choice of treatment tactics in multiple trauma patients with multiple long bone fractures of lower extremities is a relevant and controversial issue nowadays. First of all, this is due to the contradictions regarding the choice of the term and method of primary and definitive fractures fixation.Objective: to determine the impact of the proposed treatment algorithm of the multiple trauma patients with multiple long bone fractures of the lower extremities on the duration of mechanical ventilation (MV), length of stay in intensive care unit (LOS ICU) and hospital length of stay (HLOS), the incidence of complications and mortality.Materials and methods: a prospective controlled trial was conducted from September 2016 to February 2020, and included adult patients with multiple trauma, Injury Severity Score (ISS) ≥ 18p, and multiple long bone fractures of lower extremities. Patients were divided into two groups: group I included patients who were treated according to the proposed treatment algorithm. Group II includes patients who were treated in accordance with generally accepted diagnostic and treatment measures.Results: the study included 95 patients (in group I – 43, in group II – 52). There were no statistically significant differences between patients in the compared groups in terms of demographics, mechanism of injury, severity of injury and general condition of the patient, the number and location of fractures. Patients in group II, compared with patients in group I, had a higher frequency of acute respiratory distress syndrome (ARDS) (19.2% vs. 11.6%, p = 0.002), pneumonia (25.0% vs. 16.3%), p = 0.007), longer terms of MV (15.1 ± 9.4 vs. 9.6 ± 7.2 days, p = 0.004), LOS ICU (19.4 ± 12.1 vs. 13.7 ± 8.5 days, p = 0.048) and HLOS (38.7 ± 18.9 vs. 29.1 ± 15.0 days, p = 0.023).Conclusions: Complications in multiple trauma patients with multiple long bone fractures of lower extremities are often the cause of worse treatment outcomes, but the application of a differential approach, based on the proposed treatment algorithm for this patient’s category, was reduced the incidence of pneumonia and ARDS, the duration of MV, LOS ICU, HLOS, without impact on the incidence of fatal pulmonary embolism, fat embolism syndrome, sepsis, multiple organ failure and mortality.