Orthopedic injuries in patients with multiple injuries: Results of the 11th trauma update international consensus conference Milan, December 11, 2017.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Cimbanassi Stefania, O'Toole Robert, Maegele Marc, Henry Sharon, Scalea Thomas M, Bove Federico, Mezzadri Umberto, Capitani Dario, Sala Francesco, Kanakaris Nicolaus, Coccolini Federico, Ansaloni Luca, Sgardello Sebastian, Bindi Francesca, Renzi Federica, Sammartano Fabrizio, Masse Alessandro, Rampoldi Antonio, Puoti Massimo, Berlusconi Marco, Moretti Biagio, Rueger Johannes, Arnez Zoram, Del Bene Massimo, Chieregato Arturo, Menarini Maurizio, Gordini Giovanni, De Blasio Elvio, Cudoni Sebastiano, Dionigi Paolo, Fabbri Andrea, Scandroglio Ildo, Chiara Osvaldo
Аннотация
METHODS: The literature since 2000 to 2016 was systematically screened according to Preferred Reporting Items for Systematic Reviews and meta-analyses protocol. One hundred twenty-four articles were reviewed by a panel of experts to assign grade of recommendation and level of evidence using the Grading of recommendations Assessment, Development, and Evaluation system, and an International Consensus Conference, endorsed by several scientific societies was held.
RESULTS: The choice between DCO and ETC depends on the patient's physiology, as well as associated injuries. In hemodynamically unstable pelvic fracture patient, extraperitoneal pelvic packing, angioembolization, external fixation, C-clamp, and resuscitative endovascular balloon occlusion of the aorta are not mutually exclusive. Definitive reconstruction should be deferred until recovery of physiological stability. In long bone fractures, DCO is performed by external fixation, while ETC should be preferred in fully resuscitated patients because of better outcomes. In open fractures early debridement within 24 hours should be recommended and early closure of most grade I, II, IIIa performed. In mangled extremities, limb salvage should be considered for non-life-threatening injuries, mostly of upper limb.
CONCLUSION: Orthopedic priorities may be: to save a life: control hemorrhage by stabilizing the pelvis and femur fractures; to save a limb: treat soft tissue and vascular injuries associated with fractures, stabilize fractures, recognize, and prevent compartmental syndrome; to save functionality: treat dislocations, articular fractures, distal fractures. While DCO is the best initial treatment to reduce surgical load, ETC should be applied in stable or stabilized patients to accelerate the recovery of normal functions.
LEVEL OF EVIDENCE: Systematic review of predominantly level II studies, level II.