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Year 2012 Vol. 20 No 3
EXCHANGE BY EXPERIENCE
A.A. LERNER, M.V. FOMENKO
FOLLOWING “DAMAGE CONTROL” PRINCIPLES AT SEVERE LIMB INJURIES TREATMENT
Medical center “Ziv”, Safed,
High-energy injuries cause deep and extensive damages to soft tissue, to a certain extent restricting possibilities of the restorative treatment and range of medical procedures. Less traumatic methods of external fixation of fractures based on the “Damage control” principles permitting to stabilize the damaged segment of the limb with minimal additional trauma avoiding introducing foreign bodies in the damage zone are more preferable in such cases. Besides, one-side apparatuses of the external fixation practically don’t restrict surgical access to a damaged limb and don’t prevent further skin defects closure. Simplicity of this method and relatively short duration of the operation are significant for patients with multiple traumas and in cases of mass hospitalization.
The main indications for the primary stabilization with the tubular apparatuses are
– open diaphyseal and open intra-and periarticular fractures with significant damages and soft tissue defects, especially due to high-energy traumatic factors (such as Gustilo-Andersen 2-3 fractures);
– severe general condition of the victim after multiple or combined traumas requiring minimally traumatic, bloodless and rapid stabilization of the limb fractures;
– unstable fractures of the pelvis in hemodynamically unstable patients.
Further final reposition and stable fixation in the Ilizarov apparatus promotes early mobilization, including the full axial load, stimulating bone fusion and healing of the damaged soft tissues.
Minimally invasive staged treatment in the apparatuses of external fixation based on the “Damage control” principles permits to save severe-damaged limbs and to contribute to their functional recovery, in cases of extensive damage and defects of osseous and soft tissues, as well as in patients in critical condition.
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13100, Izrail', g. Tsfat, Meditsinskii tsentr «Ziv», otdeleniia ortopedii,
Lerner Aleksandr Aronovich
Lerner A.A., a Senior Lecturer of the Medical Faculty of Bar-Ilan University, Director of the Department of Orthopedics, “Ziv” Medical Center, Safed, Israel.
Fomenko M.V., Candidate of Medical Sciences, Physician of the Department of Orthopedics, “Ziv” Medical Center, Safed, Israel.