The impact of certain factors on complications development in patients with multiple long bone fractures of lower extremities and severe associated trauma

Burianov Olexandr, Dubrov Sergii, Omelchenko Taras, Lianskorunskyi Volodymyr. The impact of certain factors on complications development in patients with multiple long bone fractures of lower extremities and severe associated trauma. Journal of Education, Health and Sport. 2020;10(4):317-332. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2020.10.04.035 https://apcz.umk.pl/czasopisma/index.php/JEHS/article/view/JEHS.2020.10.04.035 https://zenodo.org/deposit/4381252 The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019. © The Authors 2020; This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 06.04.2020. Revised: 23.04.2020. Accepted: 30.04.2020. THE IMPACT OF CERTAIN FACTORS ON COMPLICATIONS DEVELOPMENT IN PATIENTS WITH MULTIPLE LONG BONE FRACTURES OF LOWER EXTREMITIES AND SEVERE ASSOCIATED TRAUMA Olexandr Burianov, Sergii Dubrov, Taras Omelchenko, Volodymyr Lianskorunskyi Bogomolets National Medical University Burianov Olexandr, Traumatology and Orthopedics Department Bogomolets National Medical University, 13 T. Shevchenko blvd., Kyiv, Ukraine, 01601 ORCID: https://orcid.org/0000-0002-2174-1882 kaftraum@ukr.net Dubrov Sergii, Anesthesiology and Intensive Care Department Bogomolets National Medical University, 13 T. Shevchenko blvd., Kyiv, Ukraine, 01601; Intensive Care Unit, Kyiv City Clinical Hospital №17, 14-20 Laboratornyi str., Kyiv, Ukraine, 01133 ORCID: https://orcid.org/0000-0002-2471-3377 sergii.dubrov@gmail.com Omelchenko Taras, Traumatology and Orthopedics Department Bogomolets National Medical University, 13 T. Shevchenko blvd., Kyiv, Ukraine, 01601 ORCID: https://orcid.org/0000-0003-1722-0803 tnomelchenko@gmail.com Lianskorunskyi Volodymyr, Traumatology and Orthopedics Department Bogomolets National Medical University, 13 T. Shevchenko blvd., Kyiv, Ukraine, 01601; Polytrauma Department Kyiv City Clinical Hospital №17, 14-20 Laboratornyi str., Kyiv, Ukraine, 01133 +38 098 824 48 66 https://orcid.org/0000-0002-1288-0688 lyanskorynsky@gmail.com Abstract The aim: to determine the influence of individual factors on the development of complications in patients with polytrauma and multiple long bone fractures of lower extremities. Materials and methods: a prospective study conducted in Kyiv City Clinical Hospital №17 from December 2016 to January 2020. The study included 57 patients with polytrauma and multiple long bone fractures of lower extremities, treated according to the proposed algorithm. Results: the most common complications were: pneumonia (21.1%), acute respiratory distress syndrome (ARDS) (15.8%), multiple organ failure (MOF) (15.8%), sepsis (8.8%), mortality (12.3%). A number of factors influenced the development of complications in patients with multiple long bone fractures of lower extremities and polytrauma were identified and the correlation analysis was conducted. These factors included: age; sex; the Injury Severity Score (ISS); the Glasgow Coma Scale (GCS); the severity of a general condition of a patient according to the Clinical Grading Scale (CGS); trauma to the head, and neck, chest, abdomen, pelvis; head and neck, chest, abdomen, pelvis trauma in accordance with the Abbreviated Injury Scale (AIS); the number of segments of damaged limbs; Gustilo-Anderson fracture type; blood loss volume; massive blood transfusions; respiratory index; duration of mechanical ventilation (MV); treatment tactics; osteosynthesis method; conversion phasing. Conclusion: the analysis allowed to identify the most significant factors that lead to complications in patients with multiple long bone fractures of lower extremities and polytrauma. Informative parameters were: for pneumonia: GCS and CGS; chest injury; AIS head and neck, chest ≥ 4; duration of MV; treatment tactics; conversion phasing (IC = 1.0-2.1). for ARDS: GCS and CGS; AIS chest ≥ 4; fractures > 2 long bones; blood loss volume; massive blood transfusions; respiratory index; duration of MV; treatment tactics (IC = 1.2-4.6). for sepsis: GCS; trauma to the chest, abdomen; AIS head and neck, abdominal cavity ≥ 4; fractures > 2 long bones; conversion phasing (IC = 1.1-3.2). for MOF: GCS and CGS; abdominal trauma; AIS abdominal cavity ≥ 4; fractures > 2 long bones; massive blood transfusions; conversion phasing (IC = 1.2-2.2). for mortality: age, ISS, GCS and CGS; abdominal trauma; AIS head and neck; chest, abdomen, pelvis ≥ 4; blood loss volume; massive blood transfusions; duration of MV (IC = 1,1-5,9). Among the factors there were those for which the diagnostic and treatment process: affected: the choice of treatment tactics (IC = 1,1-1,3); use of massive blood transfusions (IC = 1.8-4.8); duration of MV (IC = 1,2-2,1); conversion of the fixation method (IC = 1.2-1.8). did not affect: GCS (IC = 1,2-3,1), CGS (IC = 1,1-1,3), AIS (IC = 1,0-6,2). Keywords: polytrauma; long bone fractures; definitive osteosynthesis; complication; outcomes