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. 2008 Dec;32(6):753-8.
doi: 10.1007/s00264-007-0403-0. Epub 2007 Jul 3.

Analysis of management of patients with multiple injuries of the locomotor system

Dariusz Matewski  1 , Edward Szymkowiak, Piotr Bilinski
Affiliations

Analysis of management of patients with multiple injuries of the locomotor system

Dariusz Matewski et al. Int Orthop. 2008 Dec.

Abstract
in English, French

Body injuries are very serious problems in industrialised countries and they are frequent causes of fatalities in our times. The variety and multiple combinations of body injuries are a challenge for the trauma team. On the basis of clinical and radiological documentation 315 patients with multiple injuries of the locomotor system (MILS) were included in the study. The criterion for inclusion of the patients into the study group was identification of MILS. The study showed that these injuries often involve young people (53%) (predominantly men) aged between 16 and 45 years. Road accidents were the most frequent cause of injuries -80.6%. MILS affected the lower limb in 49.,4%, upper limb in 33.2% and pelvis in 14.1%; 75% of the patients studied also suffered from concomitant injuries. The head and brain were involved in 92.9%, chest in 31.5% and abdomen in 21.3%. The mortality index for the population studied was 14%. An increasing value of the Injury Severity Score (ISS) or New Injury Severity Score (NISS) caused delay in surgical management of bone injuries and correlated with prolonged hospitalisation. Analysis emphasised the usefulness of the NISS as a valuable prognostic instrument in assessment of severity of injuries in patients with multiple injuries of the locomotor system.

Les traumatismes corporels sont un problème important dans les pays industrialisés et sont de nos jours une cause fréquente de mortalité. La variété et la multiplicité des combinaisons de traumatismes représentent une véritable difficulté pour les équipes trauma. 315 patients présentant un poly-traumatisme de l’appareil locomoteur (MILS) ont été inclus dans cette étude, le critère d’inclusion dans cette étude étant l’identification du poly-traumatisme. Cette étude a montré que ce type de traumatismes survient fréquemment chez une population relativement jeune (53%) avec une prédominance masculine entre 16 et 45 ans. La cause la plus fréquente de ces traumatismes est l’accident de circulation (80.6%). Les poly-traumatismes affectent les membres inférieurs dans 49.4% des cas, les membres supérieurs dans 33.2% des cas et le bassin dans 14.1% des cas. 75% des patients ont présenté par ailleurs des traumatismes combinés, têtes et encéphales dans 92.9% des cas, thorax 31.9% et abdomen dans 21.3% des cas. Le taux de mortalité pour cette population a été de 14% des cas. L’importance de la valeur des coefficients ISS ou NISS ont été une cause importante du retard à la prise en charge chirurgicale et ont également été un facteur de prolongation de l’hospitalisation. Cette analyse permet de mettre en évidence l’importance du coefficient NISS comme un instrument pronostic de la sévérité de tous les traumatismes survenant chez ces patients.

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Figures

Fig. 1
Fig. 1
The distribution of bone and joint injuries
Fig. 2
Fig. 2
The distribution of fractures in accordance with AO and Gustilo classifications for open fracture
Fig. 3
Fig. 3
The correlation between the severity of trauma measured by ISS and NISS and applied methods of treatment
Fig. 4
Fig. 4
The correlation between time of orthopaedic surgical treatment and total duration of hospitalisation (n = 173)
See this image and copyright information in PMC

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