[Medical tactics, approaches and complex treatment effectiveness in case of multiple trauma caused by a fall from a height]. / Vrachebnaya taktika, podkhody i effektivnost' kompleksnogo lecheniya postradavshego s politravmoi, poluchennoi pri padenii s vysoty.

OBJECTIVE: To demonstrate the approaches' implementation of specialized multidisciplinary and high-tech medical care in multistage complex treatment of patient with multiple trauma including combined severe trauma of the maxillofacial region such as minimally invasive surgical tactics with early and delayed osteosynthesis (e.g. selection of optimal surgical tactics within the periodization of traumatic disease concept). Moreover, the implementation of rational advanced intensive pathogenesis drug therapy with the prevention of infectious complications in cast of severe injuries. MATERIAL AND METHODS: The tactics, approaches and results of multistage complex specialized treatment of patient K., 56 years old who has got severe concomitant injuries to various areas of the body and extremities (including multiple maxillofacial trauma) after falling from a height are presented. CONCLUSION: Rational surgical tactics and the timely initiation (immediately after admission of the victim to 1st level trauma center) of pathogenesis intensive therapy with modern drugs and antibiotics contributed to the exclusion of infectious complications in the third period (the period of maximum likelihood of complications) of traumatic illness. Comprehensive treatment of a victim with multiple trauma based on the principles of specialized, multidisciplinary and high-tech medical care is able to provide a favorable clinical outcome - the recovery with the restoration of the damaged anatomical structures functionality and the absence of cosmetic defects.

[FEATURES OF DIAGNOSTICS AND TREATMENT OF EXTREMELY SEVERE COMBINED INJURY].

The data of examination and treatment of 356 victims with extremely severe combined injury and shock of III degree were analyzed. All the patients had a medical unfavorable life prognosis. On the basis of the research, it was proved, that the modern approach of treatment of such trauma should include an adequate anti-shock treatment in conditions of the first-level trauma center. The operative activity should be increased in cases of combined trauma of bones by their early external fixation. The authors recommend an application of up-to-date prevention sepsis treatment, late reconstructive--restorative operation performance after its full relief and nutritive metabolic therapy. This approach allowed reducing of the rate of life-threaten infectious complications on 32.4% and noninfectious--on 31.7%, the lethality--on 24%.

[The effect of multiple and combined shock-inducing trauma on the processes of bone tissue reparation and on the recovery of work capacity in the victims]. / Vliianie mnozhestvennoi i sochetannoi shokogennoi travmy na protsessy reparatsii kostnoi tkani i vosstanovlenie trudosposobnosti postradavshikh.

Terms of consolidation of fractures and working ability were studied in 273 patients. Patients with multiple fractures of bones and with fractures associated with cranio-cerebral traumas were found to have slow consolidation (in 66.41%) or formation of a false joint (in 6.1%) due to severity of the trauma. It is just the cause of prolonged treatment and disability of the I or II group (in 66.6%). Active surgical treatment of such patients is necessary.