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.