SURGICAL STABILIZATION OF MULTIPLE RIB FRACTURES AND MULTIPLE LONG BONE FRACTURES OF LOWER EXTREMITIES IN POLYTRAUMA PATIENTS.

Objectives - determine the impact of rib osteosynthesis on the incidence of complications development and mortality in patients with multiple rib fractures and multiple long bone fractures of lower extremities. A prospective controlled trial was conducted from June 2015 to December 2019, and included adult patients with polytrauma, Injury Severity Score (ISS) ≥18p, multiple long bone fractures of lower extremities, one of which is the femur, and multiple rib fractures. All included patients were divided into two groups: in Group I - 17 patients who underwent surgical stabilization of rib fractures, Group II - 24 included patients treated without rib osteosynthesis. There were no significant statistic differences between patients of Group I and Group II in demographics, mechanism of injury, severity of trauma, and overall patient status. All patients had high rates of injury severity for ISS (37.8±7.9 vs. 36.9±8.6, p=0.863), New Injury Severity Score (NISS) (39.5±9.2 vs. 38.5±7.6, p=0.759) and Glasgow Coma Scale (GCS) (8.2±3.5 vs. 8.7±3.8, p=0.896).The time between trauma and rib osteosynthesis in Group I was 3.4±1.7 days. The period from trauma to definitive long bone osteosynthesis was 6.9±3.2 days in Group I and 9.4±3.8 days in Group II (p=0.039). Patients of Group I compared with Group II had a lower incidence of Acute Respiratory Distress Syndrome (ARDS) (23.5% vs. 54.2%, p=0.049) and pneumonia (29.4% vs. 62,5%, p= 0.038), shorter terms of Mechanical Ventilation (MV) (11.6±9.4 vs. 18.9±9.9, p=0.001), Length Of Stay in Intensive Care Unit (LOS ICU) (15.3±10.2 vs. 22.1±10.8, p=0.003) and Hospital Length Of Stay (HLOS) (36.9±15.8 vs. 44.3±17.4, p=0.001). Use of the rib osteosynthesis in patients with severe polytrauma, multiple rib and long bone of lower extremity fractures is more effective tactic comparing to non-surgical rib fracture treatment, it allows to reduce the incidence of ARDS and pneumonia, decreases the duration of MV, LOS ICU and HLOS.