Modern treatment tactics for diaphyseal fractures of the femur and tibia associated with multiple trauma

In solving many problems associated with polytrauma, the development of scientifically based clinical and pathogenetic concepts has played a key role. While the concepts of “multiple organ failure” (E. Faist and A. E. Baue, 1983) and “golden hour” (R. Wilder, 1984) have become widespread abroad, in our country the concept of “traumatic disease” has been actively developed and is now widely used.

The aim of this work is to analyze modern domestic and foreign literature to determine modern tactics for the treatment of diaphyseal fractures of the femur and tibia in the presence of polytrauma.

Materials and methods. In the course of the study, based on the collection of statistical data, a prospective analysis of treatment was conducted in 18 patients with various types of diaphyseal fractures of the femur (9 people) and tibia (9 people), who underwent treatment in the period 2024–2025 at the Tyumen Regional Traumatology Center. Based on the assessment using the ISS and VPH-SP scales, patients were distributed into categories of condition stability as follows: 5 people were assigned to the “stable” category; 4 people were included in the “borderline patient” group; 2 people were in the “unstable patient” category. Among stable patients, the most common concomitant injuries were: uncomplicated multiple rib fracture — in 1 patient (20%); traumatic brain injury (concussion and brain contusion) — in 3 patients (60%); type B pelvic fracture — in 1 case (20%). In the group of borderline patients, the following concomitant injuries were identified: chest trauma — in 2 patients (40%); traumatic brain injury and abdominal trauma — in 2 patients; unilateral type C pelvic fracture associated with a femur fracture — in 2 patients. The research methods used were clinical and radiological (skeletal radiography, CT).

Results. For patients in the “stable” category, the following treatment tactics were determined: surgical intervention for long bone fractures was performed in full, but only after it was possible to bring the patient out of shock and achieve normalization of his physiological status indicators. A distraction-reduction device was used to treat femur fractures. For tibia fractures, a reduction-based external fixation approach was used, using the G. A. Ilizarov apparatus. All patients in the “stable” group underwent closed intramedullary osteosynthesis, including distal and proximal interlocking.

Conclusions. Analysis of the pathogenesis of traumatic injury, combined with the use of advanced treatment technologies, enables the achievement of optimal clinical outcomes and the efficient use of resources during the inpatient treatment of patients with multiple injuries.

1. Гуманенко Е. К. Политравма и травматическая болезнь: клинические аспекты проблемы // Политравма: травматическая болезнь, дисфункция иммунной системы, современная стратегия лечения : [руководство] / под ред. Е. К. Гуманенко, В. К. Козлова. – Москва : ГЭОТАР-Медиа, 2008. – С. 313–408.

2. Гуманенко Е. К., Завражнов А. А., Хромов А. А., Жаровских О. С., Дедов А. А. Стратегия полного объема многопрофильной специализированной хирургической помощи в остром периоде травматической болезни — новая стратегия лечения тяжелых сочетанных травм и политравм // Альманах Института хирургии им. А. В. Вишневского. – 2022. – № 1. – С. 714–715.

3. Wolff G., Dittmann M., Frede K. E. Klinische Versorgung des Polytraumatisierten. Indikationsprioritäten und Therapieplan [Clinical management of the patient with multiple injuries. Indications for priorities and therapeutic plan] // Chirurg. – 1978. – Vol. 49, № 12. – P. 737–744. [In German.]

4. Bone L. B., Johnson K. D., Weigelt J., Scheinberg R. Early versus delayed stabilization of femoral fractures. A prospective randomized study // J. Bone Joint Surg. Am. – 1989. – Vol. 71, № 3. – P. 336–340.

5. Хромов А. А. Улучшение результатов лечения переломов длинных трубчатых костей при политравме : автореф. дис. ... д-ра мед. наук : 14.01.17 ; 14.01.15. – Санкт-Петербург, 2021. – 49 с.