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.

Telerehabilitation of Patients with Injuries of the Lower Extremities.

INTRODUCTION: Timely access to orthopedic rehabilitation is an important problem for the Ukrainian healthcare system. The international orthopedic community aims to achieve the best possible outcome for patient care by modifying rehabilitation methods and using telemedicine technology. The theme of this article is to discuss the integration of telemedicine technology in the rehabilitation of patients with injuries of the lower extremities. MATERIALS AND METHODS: Consecutive patients were recruited over a 2-year period. A total of 74 subjects with lower extremity injuries were enrolled in the study and monitored during a 3-month period. Twenty-six patients from the control group underwent traditional rehabilitation procedures for a 3-month period after injury. A total of 48 subjects were enrolled in the telerehabilitation group for a 3-month study period and were trained with a set of exercises for home use. Home remote monitoring for the 48 test subjects included use of a smartphone with gyroscope, G-sensor, magnetometer, and barometer, which was fixed to the injured limb. Software for the smartphone was developed at the I. Horbachevsky Ternopil Medical University, Ukraine. Software permits the monitoring of exercise time, the frequency of active movements of the injured limb, the number of steps per hour, and the walking speed. RESULTS: The 3-month rehabilitation period started with the power load of 10% of body weight, following 3-5 steps five times per day with a speed no >1 km/h. The orthopedic surgeon, during telerehabilitation, took significantly less time to consult patients (2.3 min ± 0.4) than the traditional rehabilitation (12.6 min ± 2.9). Patient satisfaction was higher for the telerehabilitation (83.1% ± 14.2) than for the orthopedic surgeon's traditional rehabilitation (33.1% ± 8.9). CONCLUSIONS: Telerehabilitation is a good alternative for providing access to specialty care for the growing number of patients with traumatic injuries.