POLYINJURY

From Big Medical Encyclopedia

POLYINJURY (grech, poly is a lot of + trauma a wound, damage) — simultaneous damage of several anatomic areas at one victim.

From the middle of 20 century in many industrialized countries, including in the USSR, in structure traumatism (see) significant increase in specific weight heavy isolated, multiple is noted and combined damages (see). Many similar lines in an etiology, clinic and treatment in this connection they are often studied have the last two appearance of injuries and describe jointly, calling polyinjuries.

According to CYTO and its wedge, bases, from all victims with injuries who are on hospitalization, P. is recorded in 9 — 15% of cases, including in 70 — 75% at persons of young and middle age, is more often at men (65 — 70%). Among the received P. at 2/3 multiple damages of the musculoskeletal device, at the others — various internal injuries, more often than a brain, combined with changes were observed. Unlike the isolated damages, at to-rykh the most frequent were household, at P. in 65% of cases as the reason served the road accidents, in 20% — falling from height (katatravma). Response of an organism to P. is not studied in detail yet, in general it is similar to that at the severe isolated injuries. At the same time clinical physicians noted that the damages making P. burden each other.

P.'s current differs in special weight: if at the isolated damages traumatic shock (see) arises at 1% of victims, at multiple fractures it is observed at 21%, at the combined injuries — at 57% of victims. After removal from shock patients with P. it is quite often long remain in a serious condition that is connected with a massive loss of blood (see. Blood loss ), with disturbance of activity of bodies and systems. Weight of the general state causes substantial increase of risk of operative measures, especially in the first days after an injury. Klien, a picture at P. is difficult and not always corresponds to localization of the dominating damage. At P. posttraumatic complications develop at 50 — 65% of victims that considerably exceeds frequency them at the isolated damages. In the early period of P. are frequent fatty embolism (see), fluid lungs (see), thromboembolism (see), acute renal failure (see). Further most often develop it is purulent - septic processes — pneumonia (see), peritonitis (see), a septicopyemia (see. Sepsis ), suppuration of wounds at open changes, etc. From complications in the late period contractures of large joints are frequent (see. Contracture ), not accrete and incorrectly accrete changes (see), osteomyelitis (see).

Feature of diagnosis of P. — its step-by-step character: at a pre-hospital stage and at arrival of the victim in a hospital the main attention is directed to identification of the dominating damage, the life-threatening victim — profuse intracavitary or outside bleedings (see), prelums of a brain a hematoma (see. Prelum of a brain ), wounds hearts (see), disturbances of passability of respiratory tracts etc. After elimination of direct threat for life there is an opportunity to carry out the specifying diagnosis of less dangerous damages, napr, fractures of bones. All diagnostic techniques at P. shall be simple and atraumatic, e.g. laparocentesis (see), a puncture of a pleural cavity, echolocation for diagnosis of an intracranial hematoma (see. Ultrasonic diagnosis ), a X-ray analysis without change of position of the victim etc.

Treatment of patients with P. is carried out according to the general principles of treatment of damages developed in resuscitation, an urgent surgery and traumatology. However medical tactics at P. has a number of peculiar features. First of all, carry out treatment of the dominating damage. E.g., at the combined injuries ruptures of parenchymatous bodies with profuse bleeding, at multiple injuries of a skeleton — open changes, dislocations in large joints can be such damages. Treatment of damages of various localizations at P. is usually performed step by step since full treatment at the same time of all traumatic centers is often almost impracticable and is risky. By drawing up tactical treatment planning, in addition to priority of therapy of this or that injury, choose such methods of treatment which would not exclude a possibility of treatment and other damages (e.g., at a fracture of a shoulder and edges — the Extra focal or submersible osteosynthesis of a shoulder, but not skeletal traction on the taking-away tire which is fixed on a thorax). At treatment preference is given to the simple and sparing methods of treatment that is connected with the high operational risk characteristic of the Item. At fractures of bones of extremities in the acute period apply skeletal extension (see), plaster bandages (see. Plaster equipment ), distraktsionno-compression devices (see).

The lethality at P. remains high: 5 — 10% at multiple fractures and 20 — 24% at the combined injuries. According to section researches, traumatic shock with blood loss, injury of a brain, infectious and septic posttraumatic complications are the most frequent causes of death at victims with P. Disability at P. reaches level 6 — 9%, a thicket after severe injuries of a brain or open intra joint changes.

Due to the increase in specific weight of victims with P. there were new organizational forms providing rendering the specialized resuscitation and traumatologic help to them: specialized crews in ambulance cars, special departments for treatment of victims with the multiple and combined injuries in multi-profile-tsakh big cities, large multi-profile-tsy ambulance. Such reorganization of medical aid is connected with the fact that treatment of victims with P. demands, as a rule, joint participation of doctors of many specialties.


Bibliography: Altunin V. F. and Sergeyev V. M. About fixing of bones at a polyinjury, Ortop, and travmat., No. 12, page 20, 1980; Zakurdayev V. E. Diagnosis and treatment of the closed injuries of a stomach at a multiple injury, L., 1976, bibliogr.; Kaplan A. V., etc. Terminological and tactical aspects of a polyinjury, Ortop, and travmat., No. 9, page 70, 1979; Lebedev V. V., Okhotsk V. P. and Kanshin N. N. Acute management at the combined traumatic damages, M., 1980, bibliogr.; Nikitin G. D., Mitya N and N. K. N and r I z N at x and E. G N. Multiple and combined fractures of bones, L., 1976, bibliogr.; P about and r and - with to and y V. F. Resuscitation at severe skeletal injuries, M., 1972, bibliogr.; Revenko T. A. and Woman's V. P. Modern problems of a polyinjury, Questions of classification and terminology, Ortop, and travmat., No. 5, page 67, 1977, bibliogr.; Revenko T. A. and Yefimov I. C. Combined injuries of a thorax and musculoskeletal system, Kiev, 1980, bibliogr.; The combined injury of extremities, under the editorship of V. M. Demyanov, L., 1981, bibliogr.; The combined craniocereberal injury, under the editorship of M. G. Grigoriev, Gorky, 1977, bibliogr.; Works of the 3rd All-Russian congress of traumatologists-orthopedists, L., 197 7; Works of the 3rd All-Union congress of traumatologists-orthopedists, M., 1976.


V. F. Pozharisky.

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