Hand telerehabilitation for polytrauma patients following road traffic accidents.

OBJECTIVE: Aim: This study aimed to examine the characteristics of upper limb and shoulder injuries combined with chest trauma in road accident victims and evaluate the effectiveness of telemedical monitoring and a newly developed telerehabilitation model in patient recovery. PATIENTS AND METHODS: Materials and Methods: Our study incorporated 136 medical records of inpatients who had sustained upper extremity and chest injuries, constituting a retrospective group. Additionally, in the main group, we included 73 patients with similar injuries of the upper extremity and chest. RESULTS: Results: We analyze the functional results between the retrospective group and the main group, providing valuable insights into the effectiveness of traditional rehabilitation versus telerehabilitation. Focusing first on the average time spent on rehabilitation exercises per day, we observe a noticeable difference: while the retrospective group dedicated an average of 29}8 minutes daily, the main group invested more time, averaging 42}4 minutes. The retrospective group reported an average of 12}2 visits, in stark contrast to the main group, which averaged only 4}2 visits. The rehabilitators spent considerably less time with each patient in the main group (92}14 minutes) compared to the retrospective group (263}15 minutes), with a significant difference (p<0.005). The discovery in our study that there was no notable statistical difference in the functional outcomes, as evaluated by QuickDASH scores, between patients undergoing telerehabilitation and those receiving traditional rehabilitation is of significant importance. CONCLUSION: Conclusions: The findings reveal that telerehabilitation can significantly increase patient engagement in rehabilitation exercises, primarily due to its convenience and accessibility.

RISK-ORIENTED ANALYSIS OF LIMB LOSS IN VICTIMS OF MODERN HOSTILITIES.

OBJECTIVE: The aim: Identification, verification and analysis of clinically effective risks of limb amputation as a basis for the formation of risk-oriented treatment and diagnostic tactics in victims with limb injuries due to modern hostilities. PATIENTS AND METHODS: Materials and methods: This research is based on a study of 1,072 cases of limb damage due to modern hostilities in eastern Ukraine in 2014-2020. All injuries were gunshot (bullet and mine injuries). According to the concept of Clinical Risk Management, Clinical Result Risk was chosen for evaluation and analysis. Risk factors - epidemiological and anatomical signs of damage. RESULTS: Results: Quantitative indicators of the clinical effective risk of limb loss are generally small and range from minimal to significant values (0.01-0.24). In some cases - up to 0.4 (significant), and are not critical and catastrophic. Of practical importance are only the risk factors associated with the nature of participation in hostilities and the anatomical characteristics of the injury. Among the immediate causes of limb loss, only primary traumatic amputation matters. Damage to vascular and nerve structures is not critical for limb loss. The impact of other risk factors may be reduced or eliminated if adequate care is provided. CONCLUSION: Conclusions: The risks of limb loss in victims of modern hostilities vary within the qualitative characteristics of the minimum-significant risk. The greatest importance in the clinical implementation of risks are risk factors related to the performance of functional duties of servicemen and anatomical features. he use of risk-based analysis must be taken into account in the formation of standards of medical care and treatment protocols for victims of modern hostilities.

TELEREHABILITATION OF THE KNEE JOINTS OF PATIENTS WITH POLYTRAUMA.

OBJECTIVE: The aim: The overarching theme of this paper is to discuss implementation of the telemedicine technology for rehabilitation of patients with injuries of the lower extremities. PATIENTS AND METHODS: Materials and methods: Consecutive patients were recruited over a four-year period. A total of 48 polytrauma patients with lower extremity injuries were enrolled in the study after the resolution of the surgical sequelae. 16 patients from the control group underwent traditional rehabilitation procedures for a 3-week period after injury. A total of 32 subjects were enrolled in the telerehabilitation group for a 3-week study period after injury and were trained with a set of exercises for home use. Home remote monitoring for the 96 test subjects included use of a Portable device with Axis-sensor, temperature and volume sensors, that were fixed to the injured limb. Software permits the monitoring of exercise time, local temperature, the biomechanics of active movements of the injured limb. RESULTS: Results: The orthopedic surgeon during telerehabilitation took significantly less time to consult patients (1.9 minutes) than the traditional rehabilitation (15.2 minutes). Patient satisfaction was higher for the telerehabilitation with machine learning algorithm (78.3%) than for the orthopedic surgeon's traditional rehabilitation (36.7%). CONCLUSION: Conclusions: Subjects reported a higher satisfaction with telerehabilitation than with the traditional orthopedic rehabilitation due to the fact that they spent less time at the hospital and had more time for exercises at home under orthopedic remote monitoring. The telerehabilitation system can be used in complex rehabilitation of patients with injuries of the lower extremities.

The main mistakes in sonographic examination of hip joints in infants under one year of age

Introduction: Developmental dysplasia of hip (DDH) remains one of the most common and severe congenital pathologies in infants. The best results of DDH treatment are observed in early-infancy up to 3 months. A sonographic examination was long recognized as a "golden standard" of early diagnosis of hip dysplasia, but some practitioners still do not trust this method through a certain number of pseudo-positive and pseudo-negative diagnoses. The aim: To carry out the quality analysis of sonographic examination of hip joints in infants under one year of age, to identify the main mistakes during the diagnosis and the causes of their occurrence; determine the dependence of the number of errors on the age of the examined child; suggest a method for assessing the quality of the received sonograms during the survey to reduce the number of false results. Material and methods: The sonographic images of the hip joints of 782 infants (1564 sonograms in total) aged 0.1­12 months were analyzed, who had been examined in Ortoclinic on the basis of Ternopil Town Clinical Hospital of Emergency Medical Care from 2016 to 2019. The ultrasound examination was performed according to a standard R. Graf technique.The comprehensive evaluation of each sonogram included the following parameters: a clear visualization of all the anatomical structures of the hip joint, the correctness of mutual spatial arrangement of the joint elements, the correct sonographic marking. Results and conclusions: 498 low-grade sonograms (31,84 %) were identified, which make impossible to objectively assess the degree of development of the joint. The basic causes of errors were found out ­ incorrect examination and incorrect estimation of the image. The use of special patterns was suggested, which helps to check the quality of the received image at once during the examination and to adjust it according to the standards.