fractura deschisa.date statistice.posibilitati terapeutice

8/13/2019 Fractura Deschisa.date Statistice.posibilitati Terapeutice.

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UNIVERSITATEAOVIDIUSCONSTANTA

FACULTATEA DE MEDICINA SI STOMATOLOGIE

REFERAT BIOSTATISTICA

FRACTURA DESCHISA.DATE STATISTICE.POSIBILITATITERAPEUTICE.

Conducator stiintific,

Conf.Univ.Dr.TEREN O.

Doctorand,

Dr.CORNELIA PANCHICI

CONSTANTA !!"

1


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Fractura deschsa este c!"sderata #ractura a care #!car c!$u"ca cu e%ter!ru&

'r"tr(! '&a)a de d$e"su" *ara+&e.Marea $a,!rtate a aut!r&!r c!"sdera #racturadeschsa s #ractura a& care #!car se deschde "tr(u" !r)a" ca*tar-*eca/rect/*a)"0.

Ter$e"u& de #ractura c!$'&cata se atr+ue ace&!r #ractur deschse as!cate cu &eu"

*ascu&!("er*!ase sau *scera&e.A&.Radu&escu c!"sdera ca d" 'u"ct de *edere 'at!&!)c

/!rce #ractura "ta& "chsa/care a #!st su'usa u"u act chrur)ca& 'e"tru !ste!s"tea sau

!ste!t!$e este ech*a&e"ta cu ! #ractura deschsa cu t!ate ca 'erc!&u& u"e c!$'&cat

$edate este $u&t $a redus.Orce #ractura deschsa tre+ue c!"sderata de te$ut de!arcec

c!$'&cat&e secu"dare-"#ecta cu 'seud!artr!a su'urata/!steta0 a'ar #rec*e"t $a a&es "

cau& u"u trata$e"t de ur)e"ta "c!rect sau "c!$'ete"t.As'ectu& 'artcu&ar a& #ractur&!rdeschse c!"sta " "t"derea s 'r!#u"$ea &eu"&!r tesutur&!r $! ce re're"ta atat

e&e$e"te de )ra*tate dar s u" crteru de c&as#care a& #ractur&!r deschse.

Fractur&e deschse c!"sttue " e'!ca $!der"a ! caua #rec*e"ta de s'ta&are

"de&u")ata/de "ca'actate te$'!rara de $u"ca/" u"e&e caur duca"d &a "*a&dtate

'er$a"e"ta/&a care se adau)a c!stur $atera&e $'res!"a"te.Dat!rta acest!r as'ecte

&e)ate de et!'at!)e"a/c&"ca s trata$e"tu& #ractur&!r deschse s(au e#ectuat 'r!)rese

tera'eutce u$t!are &e)ate de acest d!$e"u.Daca " 'r$u& ra+! $!"da& 23 d"tre

#ractur&e deschse se c!$'&cau cu ! !steta '!st#racturara/" a& d!&ea ra+! $!"da&dat!rta a'&car trata$e"tu&u de ur)e"ta s #!&!sr a"t+!tce&!r/'r!ce"tu& a scaut &a

d!ar 453.

4

CAPITOLUL I. DEFINITIE


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Fractura deschsa a e%stat d" t!tdeau"a " st!ra !$e"r/$a a&es ca ! c!"sec"ta a

ra+!ae&!r/ ca"d c!$'&cat&e se'tce duceau " $!d #rec*e"t &a e%tus.

Ma&)a)"e-1640 a#r$a ca sutura 'r$t*a " cau& #ractur&!r deschsa era cu"!scuta s

'ractcata "ca d" sec!&u& a& 7III(&ea.I" sec!&u& a& 7VI(&ea chrur)u& A$+r!se Pare trata

#ractura deschsa du'a 'r"c'&e ese"ta&e8 de+rdare/reducere

sa")era"da/esch&ect!$e/e*acuarea he$at!$u&u.T!t &u a'art" 'r$a descrere a'r!a'e

st"t#ca a u"e #ractur deschse/*a&a+&a s " ua de asta ca s 'r$a te"tat*a de

reducere chrur)ca&a a acest!r #ractur.

Mar&e desc!'err a&e &u L.Pasteur-144(1950 s :.Dster-14;(19140 au 'r!dus !

ade*arata re*!&ute " chrur)a )e"era&a s " )e"era& " chrur)a #ractur&!r deschse.Ca

ur$are a scaut se$"#cat* $!rta&tatea 'r" c!$'&cat&e #ractur&!r deschse/a crescut

"u$aru& $e$+re&!r sa&*ate/ar 'r!)"!stcu& #u"ct!"a& a de*e"t d" ce " ce $a !'t$st.

I" cursu& 'r$u&u ra+! $!"da& ! c!"duta de trata$e"t )e"era&a a'&cata de chrur)

aceste e'!c c!"sta "8 e%'&!rarea ate"ta s de+rdare &ar)a a '&a)&!r/esch&ect!$e/'&a)a&asata


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Oste!s"tea a #!st "tre*auta "ca d" 195/ ca"d Th. I!"escu a 'ree"tat

c!$u"car "teresa"te &a ce& de a& 7(&ea C!")res de Chrur)e de &a Pars. Du'a e&/ ! sere de

chrur) *a&!r!s au a'&cat s de*!&tat aceasta $et!da de trata$e"t8 A")he&/ Nasta/ :u*ara/

Iac!+!*c/ Le!"te/ Chrstde/ A. :a"u/ Fa)arasa"u/ @ut!a"u s St!a"/ Tataru s Gr)!rescu/

P!'escu etc.

La s#arstu& sec!&u&u trecut/ :u*ara s @a&acescu -19;0 #!&!seau )re#a

der$!e'der$ca du'a Thersch/ 'e"tru ac!'errea de#ecte&!r te)u$e"tare. Ne $a"dr$

cu c!"tr+uta adusa de :u*ara &a desc!'errea s "tre+u"tarea #%at!ru&u e%ter".

I. :a"u -19150 #ace c!"sderat "teresa"te asu'ra chrur)e de ra+!. I" 191/ Th.

&!"escu 'u+&ca ! a$'&a $!"!)ra#e " care #ace ! 'ree"tare c!$'&eta a trata$e"tu&u

ra"&!r de ra+! 'r" $et!da DaB"(Carre&

@reea"u -19440 aduce c!"tr+ute s su+&"aa *a&!area #%at!ru&u e%ter" "

!ste!s"tea #ractur&!r da#are. Trata$e"tu& #ractur&!r deschse de t+e a c!"sttut s

te$a u"!r tee de d!ct!rat e&a+!rate " 'er!ada "ter+e&ca -Pascu&escu T. 194/ P!'escu

S. 19?60.

La C&u,/ Des&u -19?50 e%'u"e e%'ere"ta acu$u&ata de c!&ect*u& C&"cchrur)ca&e d" C&u,/ c!"dus de A&. P!'/ " 'er!ada 1946(19?5/ "tr(! sere de caur.

La Ias/ Pa&a)hta -19?0 aduce " dscute trata$e"tu& #ractur&!r deschse " &e)atura cu

statstca C&"c chrur)ca&e c!"dusa de P. A")he&.

I" cursu& ce&u de a& d!&ea ra+! $!"da&/ chrur) r!$a" re*" $ereu asu'ra

tutur!r as'ecte&!r &e)ate de trata$e"tu& '&a)&!r de ra+! " )e"era&/ s a& #ractur&!r

deschse " 'artcu&ar/ ar d"tre acesta 'ute$ a$"t 'e P&atarea"u/ Fa)arasa"u/ @ercea"u/

Mar"/ Ghe!r)hu/ O*a"e.

I" 1951/ &a C!"#er"ta Nat!"a&a de Ort!'ede de &a T$s!ara/ se rec!$e"da

"chderea #!caru&u de #ractura su+ 'r!tecta a"t+!tce&!r s $!+&area " a'arat )'sat.I" 192/ &a C!"#er"ta de &a Oradea/ s(a "sstat asu'ra $'!rta"te re!&*ar

'r!+&e$e&!r ac!'err te)u$e"tare/ cat s asu'ra '!s+&tat de a se recur)e &a

!ste!s"tea/ " u"e&e caur de #ractur deschse.

I" 19;1 a a*ut &!c u" s$'!!" !r)a"at de U.S.S.M./ #&a&a @ucurest c!"sacrat

#ractur&!r deschse de )a$+a.

" 19;/ a a*ut &!c C!"s#aturea de &a Cra!*a cu te$a Trata$e"tu& #ractur&!r

deschse s a c!$'&cat&!r &!r. C!"c&u&e au c!"s#"tt "ecestatea "chder #!caru&u

de #ractura 'r" d*erse $et!de/ 'recu$ s su'er!rtatea reu&tate&!r !+t"ute 'r"

!ste!s"tea ce"tr!$edu&ara/ asu'ra ce&!r !+t"ute 'r" s"tee&e cu '&ac $eta&ce.

I" 19;;/ &a a V&(a Sesu"e a chrur)&!r d" M!&d!*a -Patra Nea$t0 a #!st dscutata

s #ractura deschsa/ c!"c&u&e #"d s$&are ce&!r de &a Cra!*a.

A& V(&ea C!")res Nat!"a& de Ort!'ede(Trau$at!&!)e -Ias 19940 a c!"s#"tt

"ecestatea c!&a+!rar !rt!'ed('&astca" " *ederea ac!'err 'rec!ce a #!caru&u #racturar/

ar " 'r*"ta !ste!s"tee/ $a,!rtatea 'arer&!r au #!st " #a*!area #%at!ru&u e%ter".

La C!"s#aturea Nat!"a&a de &a T$s!ara -1990/ " 'r*"ta sta+&ar #!caru&u/

'!"derea 'r"c'a&a "ce'e sa ! ca'ete !ste!s"tea ce"tr!$edu&ara.

6


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Orce c&as#care este de #a't ! u"ea&ta " $a"a s " )a"drea chrur)u&u/ ar 'e"tru

a # acce'tata ea tre+ue sa #e "u "u$a #u"ct!"a&a/ dar s ut&a. C&as#car&e s$'&e/ des

us!r de $a"e*rat -#u"ct!"a&e0/ "u su"t ut&e " trau$ats$e&e se*ere. Pe de a&ta 'arte/

c&as#car&e c!$'&e%e su"t d#c& de $a"e*rat/ dar ut&e " s'eca& " aceste trau$ats$e

se*ere.

Pr$a c&as#care $!der"a a'art"e &u Cauc#oi$ -1950/ care e*a&ueaa

gravitatea fracturii deschise in functie de marimea pierderii cutanate. Aceasta

c&as#care a re*!&ut!"at $!du& de a+!rdare a #ractur&!r deschse s a stat &a +aa sste$e&!r

de c&as#care u&ter!ara 8

( tip 1 ( '&a)a te)u$e"tara 'u"ct#!r$a/ as!cata cu &eu" su+ace"te $"!re

( tip 2 - &eu"e $a e%t"sa a 'e&/ e%sta"d rscu& a'arte u"e "ecr!e

te)u$e"tare secu"dare- tip 3 -'ree"ta u"e 'erder $'!rta"te de su+sta"ta cuta"ata s tesutur $!

su+ace"te A%&o'(r -19;10 a e&a+!rat ! c&as#care s$&ara/ a'rec"d

'r!)"!stcu& #ractur

du'agradul de lezare apartilor moi8

-tip 1 ( 'er#!rare 'u"ct#!""a a 'e&/ 'r!dusa d"au"tru "a#ara

-tip 4 ( '&a)a c!"tua 'r!dusa 'r" $eca"s$ d"a#ara("au"tru

-tip 3 - #ractura se as!caa cu &eu" e%t"se a&e 'art&!r $!

And(rson -19;10 a #!st 'r$u& care a "tr!dus ! c&as#care " care e*a&ueaa

nivelul de contaminare a focarului fracturar 8- tip 1 -'&a)a te)u$e"tara de d$e"su" $c/ as!cata cu &eu" $"$e a&e

tesutur&!r $!

-tip 2 ( 'erder $a $ar de su+sta"ta cuta"ata/ as!cata cu &eu" 'ut" "t"se a&e

tesutur&!r $! sau cu "*e& de c!"ta$"are redus a& '&a)

- tip 3 - &eu" $!derate sau e%t"se a&e 'art&!r $!/ de*ta&ate sau

c!"ta$"ate $as*

)usti%o *i And(rson -19;0 au 'us &a 'u"ct ! c&as#care ada'tata u&ter!r de

!rt!'e d" "trea)a &u$e/ care are &a +aa marimea deschiderii cutanate, gradul de lezare

sau de contaminare a tesuturilor moi si tipul de fractura. I" 196/ Gust&! s c!&a+!rat!rau subdivizat tipul III in functie de gradul de contaminare / extinderea decolarii periostale

si necesitatea interventiilor de reconstructie vasculara 8

( TipI - #r. deschse cu '&a)a cuta"ata curata/ su+ 1 c$ &u")$e

( Tip II ( #r. deschse cu 'erdere te)u$e"tara $a $are de 1 c$/ dar #ara &eu"

e%t"se a&e 'art&!r $! su+ace"te s #ara a*u&s sau &a$+!ur de 'art $!

( Tip III ( #r. deschse cu d&acerar/ &eu" sau 'erder e%t"se a&e 'art&!r $!

( !rce #r. deschsa se)$e"ta&a

5

CAPITOLUL III. CLASIFICAREA FRACTURILOR


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( !rce a$'utate '!sttrau$atca

( &eu" de e"er)e $are 'r!duse 'r" ar$e de #!c

( #r. deschse care "ecesta rec!"structe *ascu&ara

( #r. deschse $a *ech de + !re

( IIIA ( ac!'erre 'er!sta&a sats#acat!are a #!caru&u/ " cuda

&eu"&!r e%t"se a&e 'art&!r $!

( #r. 'r!duse 'r" trau$ats$e de e"er)e $are/ care "u au

c!res'!"de"ta drecta cu $ar$ea &eu"&!r cuta"ate

( B ( 'erder e%t"se de tesutur $!/ cu dec!&are 'er!sta&a/

duca"d &a e%'u"erea !su&u su+ace"t ( as!cere #rec*e"ta cu

! c!"ta$"are +actera"a $as*a

( C ( #r. deschse as!cate cu &eu" artera&e -"ecesta"d

rec!"structe *ascu&ara0/ #ara c!res'!"de"ta drecta cu

)radu& de &eare a tesutur&!r $!

I" 196/ O(st(rn si Tsc#(rn( au "tr!dus ! c&as#care 'e +aa gradului de lezare a

tesuturilor moi si extinderii contuziei musculare, e*a&uate "u$a du'a e%'&!rarea$"ut!asa a '&a) " sa&a de !'erate 8

( Grad I- c!"tue $"$a a 'e& s c!"ta$"are +actera"a "e)&,a+&a= a+se"ta

c!$"ute.

( Grad II ( &eu" c!"tue a&e 'e& s tesutur&!r $!= c!"ta$"are +actera"a

$!derata.

( Grad III ( c!"ta$"are $as*a/ dstruct "t"se a&e 'art&!r $!/ &eu"

*ascu&are s "er*!ase.

( GradI- a$'utate '!sttrau$atca t!ta&asu+t!ta&a.

I" 191/ Brd si co%a-oratorii au $!d#cat c&as#carea Gust&!/ "ssta"d 'eimportanta vascularizatiei osoase 8

( TipI ( trau$ats$ de e"er)e us!ara / #ractura cu traect !+&c sau s'r!d/

d&acerare te)u$e"tara 4 c$/ '&a)a re&at* curata/ crcu&ate e"d!sta&a

'er!sta&a "tacte.

( Tip II ( trau$ats$ de e"er)e $ede/ #r. cu de'&asare sau c!$"ut*a/

d&acerare cuta"ata 4 c$/ c!"tue $!derata a 'e& s $uscu&atur

adace"te/ #ara de*ta&area $uscu&atur/ crcu&ate e"d!sta&a

"treru'ta.

( Tip!I ( trau$ats$ cu e"er)e "a&ta/ #r. cu de'&asare $'!rta"ta s c!$"utese*era/ 'erdere te)u$e"tara "t"sa cu de*ta&area $uscu&atur &!ca&e/

crcu&ate e"d!sta&a s 'er!sta&a "treru'te.

( TipI ( trau$ats$ #. *!&e"t/ '&a)a )ra*a 'r!dusa 'r" e%'&!e sau str*re/

&eu"e *ascu&ara care "ecesta rec!"structe.

D" 'u"ct de *eder a& chrur)u&u '&astca"/ S'ar -Sar s Mears/ 1950 #ace !

c&as#care a '&a)&!r de )a$+a/ 'e +aa carea se '!ate a&e)e teh"ca de rec!"structe

a de#ecte&!r de tesutur. C&as#carea Sar este " tre tre'te 8

Defecte de tesuturi tip I Swarz. Aceasta )ru'a c!"t"e #ractur&e deschse care


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3. "odificarea leziunilor de parti %oi su'te$u%entare "contuzii musculo-

tendinoase, rupturi sau striviri musculare si sindromul de compartiment& '

J &eu"e $uscu&ara $a $ca de 16 d" crcu$#er"ta...................... 1 'ct.

J &eu"e $uscu&ara 'a"a &a 14 d" crcu$#er"taKKKKKKKK4 'ct.

J &eu"e $uscu&ara 'a"a &a ?6 d" crcu$#er"ta.............................. ? 'ct.

J &eu"e $uscu&ara $a $are de ?6 d" crcu$#er"ta.........................6 'ct.

J a$'utate 'arta&a 'r" sect!"are "c!$'&eta..................................5 'ct.

J a$'utate 'arta&a 'r" str*re "c!$'&eta........................................ 'ct.

J a$'utate 'arta&a 'r" sect!"are.....................................................; 'ct.

J a$'utate t!ta&a 'r" str*re............................................................. 'ct.

Daca su"t 'ree"te s &eu" *ascu&are/ &a 'u"cta,u& a"ter!r !+t"ut se $a

adau)a8

J 'e"tru sche$e tra"t!re..............................................................1 'ct.J 'e"tru sche$e c!$'&ete $a $ca de 6 !re..................................4 'ct.

J 'e"tru sche$e c!$'&eta $a $ca de !re..................................? 'ct.

J 'e"tru sche$e c!$'&eta $a $are de !re..................................5 'ct.

Daca su"t 'ree"te s &eu"&e "eur!&!)ce/ &a 'u"cta,u& !+t"ut a"ter!r se

adau)a8

J tu&+urar de se"s+&tate &a "*e&u& 'a&$e sau a& '&a"te....................1 'ct.

J tu&+urar a&e $!t&tat de)ete&!r......................................................4 'ct.

(. "odificarea nivelului de conta%inare&

J c!r' stra" " ca"ttate $ca............................................................1 'ct.J c!r' stra" " ca"ttate $are............................................................4 'ct.

Pe"tru c!"ta$"area +actera"a/ &a 'u"cta,u& !+t"ut a"ter!r se $a adau)a 8

J 'ree"ta u"e s'ec aer!+e............................................................... 4 'ct.

J $a $u&te s'ec aer!+e sau u"a s")ura a"aer!+a............................? 'ct.

J s'ec aer!+e as!cate cu ! s'ece a"aer!+a.....................................6 'ct.

3. "odificarea leziunilor asociate&

J #ractur $u&t'&e.................................................................................1 'ct

J &eu" a+d!$"a&e............................................................................4 'ct.

J &eu" t!racce..................................................................................? 'ct.J &eu" cra"!(*erte+ra&e....................................................................6 'ct.

). "odificarea ti%pului in care s-a acordat pri%ul a*utor calificat&

J 'r$ a,ut!r ac!rdat " "ter*a&u& (14 !re..........................................1 'ct.

J 'r$ a,ut!r ac!rdat du'a 14 !re........................................................4 'ct.

Du1a a1r(ci(r(a autori%or sca%(i Hanovra 8

J U" sc!r #"a& de 4 ( 5 'ct. c!res'u"de u"e #r. deschse de t' I Tsche$e

J U" sc!r #"a& de (19 'ct. c!res'u"de u"e #r. deschse de t' II Tscher"e


9/34

J U" sc!r #"a& de 42 ( ?2 'ct. c!res'u"de u"e #r. deschse de t' III Tscher"e

J U" sc!r #"a& ?2 'ct. c!res'u"de u"e #r. deschse de t' IV Tscher"e

I" 1992/ a #!st 'r!'usa c&as#carea )ru'u&uAO -Mu&&er s c!&a+!rat!r0/ care "c&ude

u" sste$ se'arat de a'recere a &eu"&!r cuta"ate/ a ce&!r $uscu!(te"d"!ase s a ce&!r

"eur!*ascu&are s !s!ase 8

45!eziuni ale pielii in fracturile desc+ise ,I-inte$u%ent open

J IO1 ( deschderea 'e& 'r" $eca"s$ d"au"tru ( "a#ara

J IO4 ( deschderea 'e& 'r" $eca"s$ d"a#ara ( "au"tru/ 5 c$/ cu

$ar)" c!"tue

J IO? ( deschdere cuta"ata 5 c$/ c!"tue "t"sa a 'e& s $ar)"

de*ta&ateJ IO6 ( c!"tue te)u$e"tara "t"sa ca su'ra#ata s )r!s$e / sca&'are sau 'erdere e%t"sa

de su+sta"ta cuta"ata

!eziuni %usculo-tendinoase ,Ml

J MT1 ( #ara &eu" $uscu&are

J MT4 ( &eu" $uscu&are crcu$scrse/ dar u"c!$'art$e"ta&e

J MT? ( &eu" $uscu&are a'reca+&e/ stuate &a "*e&u& a 4 c!$'art$e"te

J MT6 ( c!"tu $uscu&are "t"se/ de#ect $uscu&ar/ ru'tur te"d"!ase

J MT5 ( S"dr!$ de C!$'art$e"t S"dr!$ de str*re

!eziuni neuro-vasculare ,/J NV1 ( #ara &eu" "eur!(*ascu&are

J NV4 ( &eu"e "er*!asa !&ata

J NV? ( &eu"e *ascu&ara strct !&ata

J NV6 ( &eu"e *ascu&ara se)$e"ta&a e%t"sa

J NV5 ( &eu"e "eur!(*ascu&ara c!$+"ata/ "c&ua"d a$'utate

'!sttrau$atca su+t!ta&a t!ta&a

(eziuni osoase ( c!d#ca &!cu& s as'ectu& traectu&u de #ractura

J L!cu& ( 'e"tru !ase&e &u") 8

1 ( hu$eru&4 ( !ase a"te+rat

? ( #e$ur

6 ( t+e

( 'e"tru se)$e"te&e !s!ase 8

1 ( e'#a s $eta#a 'r!%$a&a

4 ( da#a

? ( e'#a s $eta#a dsta&a

9


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( daca #ractura de t+e se "s!teste de #ractura de 'er!"eu

1 ( 'er!"eu "tact

4 ( 'er!"eu #racturat &a a&t "*e& decat #!caru& t+a&

? ( 'er!"eu #racturat &a ace&as "*e& cu #!caru& t+a&

J As'ect traect #racturar

A ( #r. s$'&e ( A& ( traect s$'&u s'r!d

( A4 ( traect s$'&u !+&c $a $are de ?2

( A? ( traect s$'&u/ tra"s*ersa& sau !+&c su+ ?2

@ ( #r. cu a& tre&ea #ra)$e"t cc" #&uture -c!$"ute $ca0. Caracterstc este ca du'a

reducere/ #ra)$e"te&e 'r"c'a&e *" " c!"tact drect.

( @& ( traect s'r!d -c!"u& de t!rsu"e0

( @4 ( traect !+&c -c!"u& de #&e%u"e0

( @? ( traectu& 63 #&uture e as!cat cu #racturarea #&uture&u6

C ( #r. c!$'&e%e -c!$"ute $are0= du'a reducere/ #ra)$e"te&e 'r"c'a&e "u

*" " c!"tact.

( C& ( traect c!$"ut* s'r!d

( C4 ( traect cc" du+&u eta, cu #ra)$e"t "ter$edar -#ractura

se)$e"ta&a0

( C? ( traect c!$'&e%/ "ere)u&at -#ra)$e"t "ter$edar

c!$"ut*0

E%e$'&u 8 #ractura de t+e " 1? $ede cu dsta&a/ as!cata cu ! #ractura de c!&

'er!"er ( 64A14. Pr$a c#ra -60/ a d!ua -40 s u&t$a -40 "e arata u"de este #ractura/

res'ect* #ractura t+e/ !"a da#ara/ as!cata cu #ractura 'er!"eu &a a&t "*e&= A& aratacu$ este #!caru& de #ractura/ res'ect* s'r!d s$'&u.

C&as#carea AO 'er$te u" da)"!stc 'recs a& &eu"&!r s este ! $et!da us!ara

de st!care a date&!r " ca&cu&at!r.

I" a"u& 1992/ H(%f(t *i co%a-oratorii au e&a+!rat ! sca&a re&at* s$'&a

"#.).*.*. ( The Ma")&ed E%tre$t Se*ert Sc!re0 care 'er$te !re"tarea

chrur)u&u " ad!'tarea u"e dec ,a%putatie versus reconstructie7

)ru1 Ti1 Carac8

t(ristici

D(finir(a %(iuni%or Puncta9

A: In9urii a%( ; E"er)e

,!asa

P&a) 'r" ",u")here/ #ractur s$'&e "chse/ '&a)

'r!duse 'r" ar$e de #!e de ca&+ru $c.

1

sc#(%(tu%ui


11/34

0oi ? Str*r

$as*e

Accde"te " $edu "a*a&/ accde"te de tre" sau d"

"dustra 'etr!&era.

6

B. Star( d(

soc

; N!r$!(

te"s*

Te"su"e artera&a sst!&ca sta+&a " tere" " sa&a

de !'erate cu *a&!are 92$$H).

2

H'!(

te"su"e

tra"(

t!re

T. A. s ta+&a " tere"/ dar care ras'u"de &a

ad$"strarea "tra*e"!asa de #&ude.

1

> H'!(

te"su"e

're&u"(

)ta

T.A. sst!&ca 92$$H) " tere"/ dar care ras'u"de

&a ad$"strarea "tra*e"!asa de #&ude d!ar " sa&a de

!'erate.

4

C. Isc#(0ia

($tr(0itati%or

; Nu

e%sta

Me$+ru& "#er!r cu 'u&s/ #ara se$"e de sche$e

'er#erca.

2

U!ara Pu&s d$"uat #ara se$"e de sche$e. 1

> M!de(

rataL'sa 'u&su&u &a ECHO ( D!''&er/ u$'&ere &e"ta a

'atu&u ca'&ar/ 'areste/ act. $!t!re d$"uata.

4

? A*a"(sata

L'sa 'u&su&u/ e%tre$tate rece/ 'ara&ata a$!rtta/ #ara u$'&erea 'atu&u ca'&ar.

?

@arsta

1aci(ntu%ui

; ?2a" 2

?2(52a" 1

> 52a" 4

sc!r du+&u daca sche$a dureaa de 'este !re

Ta'el I

U" sc!r MESS ; c!"sttue u" su'!rt ,ust#cat 'e"tru deca de a$'utate.

C&as#care Stoc/ -St!cB s Her"er/ 19960 se re#era d!ar &a #ractur&e de )a$+a s este !

c&as#care 'e +aa carea/ du'a 'arerea aut!r&!r/ se '!atepune indicatia dereconstructie adefectelor de tesuturi.

Aut!r e*de"taa $'!rta"ta de!se+ta a ac!'err #!caru&u de #ractura cu $usch

sau cu 'er!st *a+&. D" acest 'u"ct de *edere e c!"sdera ca #!caru& se '!ate a#&a8

J "tr(u" &!c !ste!)e"c/ dec +"e ac!'ert

J "tr(u" &!c 'arta& !ste!)e"c/ dec 'arta& ac!'ert

J "tr(u" &!c "e!ste!)e"c/ dec "eac!'ert

De ase$e"ea/ e descru &a )a$+a tre !"e de $"$a reste"ta/ !"e " care 'e"tru

ac!'errea de#ecte&!r "u se rec!$a"da #!&!srea )re#e de 'e&e &+era des'cata8

J in treimea superioara ( e'#a 'r!%$a&a a t+e s $ar)"ea a"ter!ara a$eta#e

J in treimea medie ( #ata a"ter!("ter"a a t+e

J in treimea inferioara ( "trea)a crcu$#er"ta

C&as#carea 'r!'ru(sa $'arte de#ecte&e ce '!t # "ta&"te "tr(! #ractura deschsa

de )a$+a " tre )ru'e 8

J defecte de tesuturi tip $ *toc+ ( de#ecte #asc!cuta"e

J defecte de tesuturi tip B *toc+ ( de#ecte $%te de 'art $! -'e&e/ $usch s

11


12/34

a&te 'art $!0

J defecte de tesuturi tip C *toc+ ( de#ecte de 'art $! as!cate cu de#ecte de

OS

Pe +aa aceste c&as#car aut!r sta+&esc "dcat d#erte de rec!"structe 'e"tru

de#ecte de t' d#ert. I" #ractur&e deschse de )a$+a cu de#ecte de t' A sau de t' @/ du'a

#%area #!caru&u de #ractura cu $,&!ace ce"tr!$edu&are/ rec!"structa de#ectu&u de tesutur

se #ace cu 8

J grefa de piele libera despicata daca de#ectu& este " a#ara !"e&!r de $ca

reste"ta

J lambouri locale -#asc!cuta"e sau $!cuta"e0 sau lambouri libere

-$cr!*ascu&are0 daca de#ectu& este "tr(! !"a de $ca reste"ta

I" #ractur&e deschse de )a$+a cu de#ecte de t' C/ du'a #%area !su&u 'r" $,&!ace

e%ter"e/ rec!"structa de#ectu&u de tesutur se #ace ast#e&8

J Intr-o singura etapa chirurgicala -!s Q 'art $!0 daca de#ectu& este "tr(u"

&!c !ste!)e"c -#ra)$e"te de !s +"e ac!'erte as!cate cu de#ect $c de

'art $!0. Rec!"structa "tr(! s")ura eta'a se #ace 'r" &a$+!u c!$'!t

!ste!($!(cuta" &+er -$cr!*ascu&ar0.

J In mai multe etape chirurgicale daca de#ectu& este "tr(u" &!c 'arta&

!ste!)e"c sau "e!ste!)e"c -#ra)$e"te de !s "eac!'erte as!cate cu

de#ect $are de 'art $!0. Rec!"structa 'resu'u"e ! 'r$a eta'a de )re#are

cu u" $usch +"e *ascu&arat/ care *a tra"s#+r$a &!cu& "e!ste!)e"c "tr(u"

&!c !ste!)e"c. I" eta'a ur$at!are se *a 'ractca )re#area !s!asa/ ar )re#a *a #

'&asata " &!cu& !ste!)e"c "!u creat.

Aut!r c!d#ca de ase$e"ea teh"ca de )re#a, " #u"cte de d$e"su"&e

de#ectu&u !s!s8

J defecte de os sub 3 cm ( )re#a de !s s'!")!s

J defecte de os intre 3 si 1 cm - )re#a de creasta &aca *ascu&arata

-$cr!*ascu&ar0

J defecte de o speste 1 cm- )re#a #+u&ara *ascu&arata

Des c&as#carea St!cB "u este ! c&as#care 'r!'ru(sa a #ractur&!r deschse/ are !

$'!rta"ta de!se+ta " sta+&rea crter&!r de rec!"structe.

Nu$aru& $are de 'ace"t '!&trau$atat cu #ractur deschse a&e )a$+e rdca

'r!+&e$e " e*a&uarea )ra*tat s trata$e"tu& acest!ra. D" acest $!t*/ Ver$esa" s

c!&a+!rat!r -19990 'r!'u" u" coeficient de gravitate 'e"tru e*a&uarea 'ace"t&!r

'!&trau$atat/ c!e#ce"t care de'"de de ur$at!r #act!r8

A0 Fact!r &!ca&

a0 Fractur

( #r. s$'&e ( #r. a&e !ase&!r $c (1 '

( #r. a&e !ase&!r &u") ( 4 '

( #r. c!$"ut*e ( ? '

14


13/34

( #r. deschse ( t' I -Gust&!(A"ders!"0 (1 '

( t' II ( 4 '

( t' $ ( ? '

( " cau& as!cer cu ! #ractura artcu&ara ( 1 ' " '&us

+0 Leu" as!cate #ractur

( &eu" $uscu&are "t"se ( 4 '

( &eu" *ascu&are ( artere $c s $ed (1 '

( *e"e $ar ( 4 '

( artere $ar ( 4 '

( &eu" "er*!ase ( a&u")rec!$'resu"e de "er* 'r"c'a& ( 4 '

( sectu"e de "er* 'r"c'a& ( 4 '

Per!ada de t$' de &a accde"t -" cau& #r. deschse0 8

( h ( & '

( ( 1 4 h ( 4 '

( 1 4 h ( ? '

@0 A&te a#ectu" as!cate #ractur&!r deschse 8a0 S!c ( 'resu"e sa")u"a sst!&ca &OO$$H) ( 4 '

( 'resu"e sa")u"a sst!&ca 2$$H) ( ? '

+0 Leu" $a,!re as!cate ( s$'&e ( ? '

( c!$'&e%e ( 5 '

Su$a 'u"cte&!r !+t"ute re're"ta c!e#ce"tu& de )ra*tate 'e care aut!r 1(au

c&as#cat " 6 )ru'e 8

J coeficient de gravitate I "1- p& ( #r. s$'&e 'r!duse de u" trau$ats$ cu

e"er)e $ca=

coeficient de gravitate II "-1 p& ( trau$ats$ cu e"er)e $are cu c!$"ute

sau #r. deschse de )rad $c=

coeficient de gravitate III "1-1 p& ( trau$ats$ cu e"er)e $are= &eu" a&e

!r)a"e&!r "ter"e=

coeficient de gravitate I " 1 p& ( trau$ats$ cu e"er)e #!arte $are cu

&eu" s$u&ta"e &!c!$!t!r/ t!rac!'u&$!"are sau cra"e"e.

Nc u"u& d" sste$e&e de c&as#care a #ractur&!r deschse "u este 'er#ect/ e&e

tre+u"d ada'tate #ecaru ca " 'arte. C&as#carea &u Gust&!/ +aata 'e studu&

retr!s'ect* s 'r!s'ect* a 1245 caur de #ractur deschse a&e !ase&!r &u")/ tratate

ur$arte " 'er!ada 1955(19;?/ este cea $a #!&!sta c&as#care 'e '&a" "ter"at!"a&/

dat!rta a'&ca+&tat sa&e $edate " 'ractca trau$at!&!)ca.

1?


14/34

;.Dina0ica 0or-iditatii 1rin fracturi d(sc#is(.

Cresterea c!"t"ua a "u$aru&u de accde"te " t!ate tar&e a #acut ca &eu"&e

trau$atce sa !cu'e &!cu& tre s char d! " cadru& $!r+dtat )e"era&e ast#e& "cat a a,u"s

sa c!"sttue ! 'r!+&e$a s!ca&a de "teres $a,!r.I$e"sa $a,!rtate a accde"te&!r s!&date

cu #ractur deschse au dre't caue 'r"c'a&e "eres'ectarea dsc'&"e&!r rutere s "!r$e&!r

de 'r!tecta $u"c.

Acest &ucru se ra'!rteaa s " &teratura $!"da&a de e%e$'&u8 daca " 195 " Tu&!use este

a"a&ata ! statstca de 46 de #ractur d"tre care ?23 su"t #ractur deschse/ " 1992 sera'!rteaa ! 'r!'rte de 623.La "! " tara/ C&"ca de Ort!'ede s Trau$at!&!)e @ucurest

e#ectua"d u" studu 'e ! 'er!ada de 16 a"-19?(19;0 c!"stata ! crestere $arcata a "cde"te

acest!r &eu" trau$atce ca"d s(au "re)strat 543 d" caue.

I" C!"sta"ta " 'er!ada 4222(4224 " C&"ca de Ort!'ede s Trau$at!&!)e au #!st "ter"at

1;12 'ace"t d"tre care 4;2 'ace"t au 'ree"tat #ractur de )a$+a.D" acest "u$ar t!ta&

de 'ace"t cu #ractur de )a$+a 192 au 'ree"tat #ractur "chse ar 2 au #!st cu #ractur

deschse re'ree"ta"d 493.

Anul Nr. cazuri

1963 145

1964 157

1965 152

1966 158

1967 66

1968 1441969 64

1970 125

1971 182

1972 257

1973 214

1974 304

1975 234

1976 298

Total 2 500

16

CAPITOLUL I@. STATISTICA


15/34

Ta+e& II ( C&"ca de Ort!'ede s Trau$at!&!)e @ucurest-Studu Statstc 19(19;0

Ta'el III -Clinica de Ortopedie si Traumatologie Constanta(Studiu Statistic 2000-2002)

.Structura 0or-iditatii 1( &ru1( d( varsta si s($(.

D" a"a&a date&!r d" &teratura de s'eca&tate reu&ta ca "cde"ta

$a%$a a #ractur&!r deschse se su'ra'u"e 'este 'er!ada cea $a act*a a

*et-15(6 de a"0.Aceasta c!"statare este a+s!&ut "!r$a&a de!arece #ractur&edeschse sur*" " s'eca& &a !a$e" *a&/$a,!rtatea "te)rat " 'r!cesu&

'r!duct*/&a 'ers!"ae care se de'&aseaa d"tr(u" &!c " a&tu& #!&!s"d " $!d

#rec*e"t $,&!ace&e rutere.

Tota% 1aci(nti

int(rnati

Paci(nti cu fr.

d(sc#isa d( &a0-a

Paci(nti cu fr. inc#isa

d( )a$+a

1;12 +! 192

15


16/34

/$B)(0( I ( REPARTIAREA CAURILOR PE GRUPE DE VARSTA SI SE7E

U" studu e#ectuat de G!ru" s Tr!a"escu -19;9(@ucurest0arata ca

#rec*e"ta #ractur&!r deschse este de tre !r $a $are &a se%u& $ascu&"-;6.30 c!$'arat* cu se%u& #e$"" -45.430.Acest ra'!rt de #rec*e"ta ? M1F

este "!r$a& de!arece su"t $a $u&t +ar+at a")re"at " $u"c #ce )re&e/

$a,!rtatea aut!*ehcu&e&!r su"t c!"duse de +ar+at/#e$e&e #"d $u&t $a

ate"te atat &a *!&a" cat s ca 'et!".

Gru'a de *rsta Nr. caur

-a"0 M ' T!ta&

2(16 ? 9 2/6

15(46 4;9 ;5 ?56 16/445(?6 ?95 94 6; 19/5

?5(66 6?; 1?6 5;1 44/65(56 ?94 119 511 42/6

55(A6 4?6 9 ??4 1?/?A5(;6 94 ;1 1? /5

;5 s 'este ? ?; ;? 4/9

T!ta& 1;1 49 4 522

-;6/30 -45/430 122/2

1


17/34

R(1artitia cauisticii in functi( d( s($

+;

;6@ar+at

Fe$e

/arsta (1(?2 a" ( 43 -44 'ace"t0

( ?1(52 a" ( 693 -? 'ace"t0

( 52 a" ( 4? 3 -1 'ace"t0

Fi&83 R(1artitia cauisticii 1(

&ru1( d( varsta

?6

+

;+8>! ani

>; 83! ani

53!ani

LOT 2PACIENTI(SPITALUL CLINIC :UDETEAN CONSTANTA -4222(42240

>

2-1 1-2 2-3 3- - - -

1;

22

522

622

?22

422

122


18/34

STUDIU STATISTIC CLINICA DE ORTOPEDIE @UCURESTI -19(19;0

>.Structura 0or-iditatii in functi( d( s(on si ora 1roduc(rii.

Re'artarea caur&!r cu #ractur deschse 'e a"!t$'ur arata ! "cde"ta

$a%$a " &u"&e de *ara s t!a$"a/ c"d s(au "re)strat/ &a u" &!c/ 1 2; caur

-;4/630/ #ata de &u"&e de 'r$a*ara s ar"a/ c"d s(au "re)strat 9? de caur

-4;/30. - D" acest )ra#c reu&ta cu c&artate ca " &u"&e de ar"a/ " cuda a'e/

)het s '!&eu&u/ dec a 'erc!&u&u $a $are de a&u"ecare s cadere/ se "re)streaa

t!tus ce& $a $c "u$ar de #ractur deschse. D" acest studu/ 'ute$ tra)e c!"c&uaca #rec*e"ta rdcata a "u$aru&u #ractur&!r deschse d" &u"&e de *ara s t!a$"a

tre+ue 'usa $a a&es 'e sea$a "$u&tr $'res!"a"te a $,&!ace&!r 'ers!"ate s

c!&ect*e de tra"s'!rt/ crcu&ata #"d $u&t $a redusa " &u"&e de ar"a.

IARNA PKIMAVARA YARA TOAMNA

1


19/34

Fi$. 3

Stractura $!r+dtat 'r" #racturdeschse " #u"c,c de se!".

I" #u"cte de !ra 'r!ducer accde"tu&u.-G!ru" sTr!a"escu(19;90

1227000 -

51

6

600 -

200

12 7

1 7

600

eoo

400

2

19


20/34

?.Structura 0or-iditatii in functi( d( (tio%o&i(

Accde"te&e de crcu&ate se a#&a 'e 'r$u& &!c " et!&!)a #ractur&!r/e&e #"d

res'!"sa+&e de a'r!a'e ,u$atate d" "u$aru& t!ta& a& #ractur&!r deschse/ " *re$e ceaccde"te&e de $u"ca se stueaa 'e &!cu& a& d!&ea.Pe &!cu& tre se c&aseaa accde"te&e

d*erse s "e'recate ur$ate de accde"te&e cas"ce s accde"te&e de s'!rt.

Etio%o&ia fracturii d(sc#is( d( &a0-a

Accid(nt( ruti(r(

Accid(nt( d( 0unca

Accid(nt( casnic(

A&r(siuni

Accid(nt( n(1r(ciat(

Studiu statistic S1ita%u% Cinic ud(t(an Constanta !!!8!!%ot 8+! 1aci(nti

3.Structura 0or-iditatii in ra1ort cu s(diu% fracturii si ti1u% d(sc#id(rii


21/34

t(&u0(ntar(

Se re$arca #a'tu& ca #ractur&e deschse de )a$+a c!"sderate )&!+a&-#ractur a&e

a$+e&!r !ase/#ractur de t+e s #ractur de #+u&a0 re're"ta 'este ,u$atate d" t!ta&uractur&!r deschse -55.63 ra'!rtat de G!ru"0.Pe +aa statstc ce"tru&u de

trau$at!&!)e d" @!rdeau% 195 Pate& s c!&a+!rat!r ra'!rteaa ?.?3 'r!ce"tu&

#ractur&!r deschse.Pr!ce"te&e *araa "sa s " #u"cte de s'ec#cu& ser*cu&u

res'ect*-ser*cu& de ur)e"ta sau de +!&"a* cr!"c/chrur)e )e"era&a sau

trau$at!&!)e0.Pe &!cur&e ur$at!are se stueaa #ractur&e deschse a&e

a"te+ratu&u/#a&a")e&!r 'c!ru&u/#e$uru&/hu$erusu&/etc.

Re'ree"tarea ce&!r $a #rec*e"te &!ca&ar a&e #ractur&!r deschseGORUN (19;9


22/34

D" 'u"ct de *edere a& $eca"s$u&u &eu"&!r te)u$e"tare d!$"a de de'arte

a)e"tu& *u&"era"t drect/&eu"&e te)u$e"tare *ar"d de &a '&a) 'u"ct#!r$e s$'&e

'a"a &a dec!&ar te)u$e"tare "t"se/cu sca&'ur *ara+&e s u"e!r str*r )ra*e de

$e$+re.I" t$' ce ! '&a)a 'u"ct#!r$a "u rdca "c ! d#cu&tate tera'eutca-sutura

'r$ara du'a t!a&eta chrur)ca&a0dec!&ar&e te)u$e"tare "t"se s dr!+r&e de

tesutur $! rdca 'r!+&e$e c!$'&e%e atat d" 'u"ct de *edere a& trata$e"tu&u cat s

a& 'r!)"!stcu&u.I"tre aceste d!ua e%tre$e se "ta&"esc #!arte $u&te as'ecte

"ter$edare cu '&a) &"are sau ste&ate cu sau #ara dec!&ar /cu &eu" d*erse a&e

tesutur&!r $! su+cuta"ate.

Tr!a"escu s c!&a+.ra'!rteaa ca d" 1?6de #ractur deschse de

Ga$+a -55/63d" t!ta&u& #ractur&!r deschse0/ 11?5 "tereseaa a$+e&e !ase/-cu122

deschder " #!caru& t+a&/6 de deschder " a$+e&e #!care s 65 de deschder "#!caru& #+u&ar0/41#ractur deschse de t+e s?? de #racture deschse de #+u&a.

As!cer&e &e!"are su"t "u$er!ase s *arate/c!"tr+u"d &a a)ra*area e*!&ute

#ractur deschse "tr(u" 'r!ce"t $c de caur.Ast#e& #ractura deschsa trece 'e '&a"u&

secu"d sau 'e u&t$u& &!c " c!"te%tu& c&"c a& u"!r '!&trau$ats$e.

".Princi1ii d( trata0(nt a% fracturii d(sc#is(.

P&a"u& tera'eutc a'&cat este $'us de )ra*tatea &eu" &!ca&e s a &eu"&!r as!cate

" c!"te%tu& s!cu&u s a& '!&trau$ats$e&!r.Sche$atc se eta'eaa ast#e&8

( re!&*area &eu"&!r &!ca&e > trata$e"tu& &eu"&!r 'art&!r $!

sta+&area #!caru&u de #ractura

( trata$e"tu& de des!care c!"sta"d "8

reech&+rare he$!hdr!e&ectr!&tca

'r!#&a%a deech&+ru&u #&ud!c!a)u&a"t

( trata$e"tu& &eu"&!r ass!cate " c!"te%tu& '!&trau$ats$u&u

( 'r!#&a%a "#ecte '&a) #racturare -a"t+!tc!tera'a0/a "#ecte teta"ce/a

)a")re"e )a!ase.

( trata$e"tu& a#ectu"&!r 'ree%ste"te-da+et/+!& card!*ascu&are/seche&e

"eur!&!)ce/etc.0


23/34

.Trata0(ntu% %oco8r(&iona% a% fracturi%or d(sc#is(.

E%sta tre 'r"c' $ar " trata$e"tu& de ur)e"ta a& u"e #ractur deschse8

( e%ca tesutur&!r de*ta&ate=

( c!"ser*area !rcaru e&e$e"t a"at!$c &eat/'e cat $a $u&t '!s+&=

( !rce ra'!rt a"at!$c sch$+at tre+ue resta+&t.

Du'a G!ru" $a,!rtatea "ter*e"t&!r 'ractcate -5.?30 au #!st !'erat

$"$e dar cu e#ce"ta $a%$a c!"sta"d "8

( t!a&eta ch$ca s $eca"ca r)ur!asa=

( e%ca 'e&/tesutu&u su+cuta"at dr!+t/#ra",ur&!r a'!"e*r!tce s$uscu&are=

( reducerea !rt!'edca a #!caru&u de #ractura=

( $!+&area se)$e"tu&u " a'arat )'sat sau e%te"se c!"t"ua

tra"ssche&etca.


24/34

W Structura $!r+dtat 'r" #ractur deschse " ra'!rt cu t'u& "ter*e"te 'ractcate.

Trata0(nt a1%icat Tota%

Toa%(ta G sutura fara i0o-i%iar(

Toa%(ta 8 sutura G i0o-i%iar( ;?!" 3",>Toa%(ta G ost(osint(a 1ri0ara G sutura 1ri0ara +3 >;,?

Toa%(ta 8f ($cii( %ar&a fara sutura G i0o-i%iar( ;!+ ?,3A01utatii si r(tusari d( -onturi trau0atic( ;!? ?,

P%astii cutanat( in ur&(nta "; ,?R((ctii osoas( >! ;,

T(norafii ?> ;Li&aturi art(ria%( ;3 !,"R(duc(ri orto1(dic( d( %u$atii d(sc#is( 6 ;,R(duc(ri orto1(dic( d( fracturi d(sc#is( 6!+ >",>E$tra&(ri d( unii 6 ;,

E$t(nsii transosoas( 6+ ;;,6

/ratamentul leziunilor asociate

Ost(osint(( 0(ta%ic( o%(cran, ant(-rat, 0(tacar1i(n(, f(0ur,

1at(%a, &a0-a, 0(tatarsi(n( (tc. 6+

Suturi d( 1%a&i div(rs( ;!R(duc(ri orto1(dic( in fracturi div(rs( ;!+

R(duc(ri d( %u$atii div(rs( 6"E$t(nsii transosoas( 3+

Punctii d( #(0atoa0( si #(0artro( vo%u0inoas( >6


25/34

REPARTIAREA FRACTUIOLOR DESCHISE DIN SERIA NOASTRA IN FUNCTIE DE TRATAMENTU L A PLIC AT

C!"dta dea&a este ac!'errea #!caru&u de #ractura 'r"tr(u" '&a" $uscu&ar s a&tu&

te)u$e"tar.Nu se *!r e#ectua sutur " te"su"e/" cau& s"dr!$u&u de c!$'art$e"t

se *!r e#ectua #asc!t!$ &a "*e&u& &!,e&!r $uscu&are te"s!"ate.L'sa de su+sta"ta

te)u$e"tara se *a c!$'&eta #e cu )re#e de 'e&e/#e cu as!cerea &a$+!ur&!r

$uscu&are-&!ca&e sau de &a dstata as!cata cu )re#area de 'e&e.Sta+&area #!caru&u

de #ractura este ! a d!ua c!"dte !+&)at!re s're e*!&uta de *"decare s a #!caru&u

de #ractura s " ace&as t$' 'e"tru ! +u"a ccatrare a &eu"&!r $uscu&!(

te)u$e"tare.

Oste!s"tea 'r$ara c!"sta " a&e)erea $et!de ce&e $a s)ure ce *a as)ura #%area

cea $a s!&da a #ra)$e"te&!r !s!ase cu res'ectarea r)ate sa")u"e atat a !su&u cat

s a'art&!r $!.Du'a G!ru" " ;5 de caur s(au e#ectuat8

( 49 !ste!s"tee $"$e=

( 69 !ste!s"tee #er$e cu +r!se Xrscher/t,e Xu"tscher/suru+ur/'&a)

"suru+ate/t,e E"der/#%at!r e%ter" E&ar!*.

Mar&e dstru)er te)u$e"tare au $'us u" trata$e"t de aste'tare8t!a&eta s

e%ca &ar)a 'a"a " tesut sa"at!s "u au $a 'er$s sutura 'r$ara.De aceea

reducerea #ractur a #!st ur$ata de $!+&are " a'arat )'sat cu #ereastra.

I" statstca e#ectuata &a C&"ca de Ort!'ede s Trau$at!&!)e @ucurest se re$arcau" "u$ar re&at* $are - 6.430 de a$'utat s retusar de +!"tur trau$atce.

Pe &!tu& de 2 de +!&"a* "*est)at " C&"ca de Ort!'ede a S'ta&u&u C&"c

:udetea" C!"sta"ta trata$e"tu& de#"t* a c!"stat "8

. Trata%entul definitiv al fracturilor desc+ise ,sinteza pe 01 de fracturiTip Metode c+irur$icale de

rezolvare aparfilor %oi

Nr. Metode de sta'ilizare a

fracturii ,steosinteza

r. Metode de

sta'ilizare

ortopedica

r.

I

( #ara sutura -'&a)

'u"ct#!r$e0

( sutura 'r$ara

1;

14

OS "t ce"tr!$ed " #!car

1

4

?

1

( a'arat )'sat

6

"chs

( t,e e&astce t' E"der

( t,a Xu"tscher #ara a&ea,

( t,a Xu"tscher cu a&ea,

OS "t. " #!car deschs

( '&aca cu uru+ur Q )re#a

c!rtc!s'!")!asa


26/34

II ( sutura 'r$ara

( sutura secu"dara -46h0

( sutura eta'ata -;(12

&e0

( sutura Q PPLD

(a$'utate de "ecestatecu +!"t deschs s

sutura tard*a

1

12

4

4

1

OS "t. ce"tr!$ed. " #!car

11

?

?

4

4

;

( a'arat )'sat ?

"chs


( t,a Xu"tscher #ara a&ea,

( t,a Xu"tscher cu a&ea,OS "t. " #!car deschs

>;

( '&aca cu uru+ur (

uru+ 'ercuta" !&at

OS e%ter"a

( #%at!r e%ter"

IIIA ( sutura 'r$ara ( suturaeta'ata -;(12 &e0

(PPLD

6

6

?

OS "t. ce"tr!$ed. " #!car

?

4

W W

;;

"chs


OS "t. " #!car deschs

( ? +r!e 'ercuta"e OS

e%ter"a

( #%at!r e%ter"

IIIB

( sutura eta'ata -;(12

&e0

( sutura Q PPLD

(PPLD

( PPLD Q &a$+!u #asc!(

cuta"

1

1

?

1

OS e%ter"a

( #%at!r e%ter"

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IIIC4

( a$'utate de "ecestate

cu +!"t deschs s sutura

tard*a

4

+. Anti-ioticot(ra1ia

Ut&area a"t+!tce&!r cu s'ectru &ar) " sc!' 'r!#&actc este "ecesara dat!rta

rscu&u rdcat de "#ecte creeat 'r" e%ste"ta s!&ute de c!"t"utatea cu $edu&

e%ter!r.Daca &a "ce'ut "stturea trata$e"tu&u se #ace 'e crteru& de 'r!+a+&tate-a"t+!tce cu s'ectru &ar)('e"c&"a/)e"ta$c"a/$etr!"da!&0 u&ter!r c!"t"uarea

sa se e#ectueaa 'e +aa a"a&e&!r de &a+!rat!r ce ra'!rteaa se"s!+&tatea )er$e"&!r

&a a"t+!tce.

I.Infectia fracturii ,aspecte statistice co%parative


27/34

Clinica de %rtopedie, 8ac. de

#edicina - Constanta, 9omania

Clinica de %rtopedie 0niv. de

#edicina - :itasato, ;aponia

T'#r. I"#ecta '&a) T'#r. I"#ecta '&a)

Nr. 3 Nr. caur 3

I8(49#r. 2 23 I(64#r. 2 23II(?1#r. 9 49.2?3 II(12;#r. 6 ?.;?3

IIIA(11#r. ; ?.?3 IIIA(6?#r. ? .9;3III@(#r.. 5 ?.??3 III@(64#r. 14 4.5;3IIIC ( 4 #r. 4 1223 IIIC(11#r. 4 1.13

6.Trata0(nu% Socu%ui 2i$t

Reech&+rarea he$!hdr!e&ectr!&tca este a'&cata atat &a "*e&u& ca$ere deresusctare cat s/" sa&a de !'erate 'receda"d trata$e"tu& &!c!re)!"a& s c!"t"uata

" STI daca starea )e"era&a ! $'u"e.

I" caustca C&"c de Ort!'ede S'ta& C&"c :udetea" C!"sta"ta 'e u" &!t de 2 de

+!&"a* s(a c!"statat 8

I" caustca a"a&ata/ "u au #!st c!"statate &eu" as!cate '!&trau$ats$u&u care sa

r. cazuri

Trata%entul 2ocului %it Reech&+rarehe$!(hdr!(e&ectr!&tca

-sa")e !)ra'/ ! Rh/ ser/

)&uc!a/ '&as$a/ NaC&/ XC10

Reech&+rare hdr!(e&ectr!&tca

-ser/ )&uc!a/ '&as$a/ NaC&/5

Seroprofilaia AT Vacc"are ATPA -1 #!&a ( 2/5 $&0 SerAT -?222 UI ( dese"s+&are &e"ta0 ;

4rofilaia 'olii Fara $edcate 44

tro%'oe%'olice C&e%a"e ?2

C&*ar" 15

Fra%'ar" 5

C&e%a"e/ He'ar"a/ Ca&c'ar"a ?

C&e%a"e/ C&*ar" 4

He'ar"a/ C&*ar"/ Ca&c'ar"a 1


28/34

$'u"a u" trata$e"t "eur!chrur)ca& sau chrur)ca&/ t!rac!('u&$!"ar/a+d!$"a& etc.

1. )ste necesara evaluarea corecta a gradualitatii lezionale, atat la

internare,in urgenta, cat si in etapele ulterioare. % interpretare flziopatologica

corecta a modificarilor hemodinamice sistemice si loco-regionale, al integritatii

structurilor rmicrocirculatorii si al gradului lor de permeabilitate,permite

formularea unei strategii terapeutice corespunzatoare.

2. Caracteristicile anatomice, etiologice si fiziopatologice ale gambei impunfracturilor deschise caracteristici lezionale diferentiate, aspecte clinice multiple,

dificultati terapeutice si prognostic uneori incert.

3. 8recventa fracturilor deschise de gamba este in crestere datorita traficul

rutier si a accidentelor de munca, existand un procent ridicat la categoriile de varsta

activa, predominent la sexul masculin.

CAPITOLUL @. CONCLUII


29/34

.Caracteristicile focarului de fractura vor fi consecinta intensitatii si modului de

aplicare al mecanismului traumatic. $spectul de focar simplu, cominutiv

(plurieschilos poate sugera nivelul energiei traumatice..

. /ipul lezional fracturar trebuie evaluat pe baza criteriilor clinice si

prognostice continute de clasificarea Cauchoix-


30/34

41(4? Oct 199

. Bora Iconia 89ezultatele tratamentului chirurgical amdnat in fracturile deschise,

C!"#er"ta Nat!"a&a de Ort!'ede Trau$at!&!)e/ 9/ T$s!ara/ 41(4? Oct./ 199

;. Bra'n C.YHe"ders!" S./ M!!re S. = *urgical treatment of patients Aith open tibial

fractures. Re*e ?1 re#s8 AORN :!ur"a&/ ?-50/ ;5(/ 5(9/ 99(92/ 199 Ma

. C#in(u R. 89ezultatele tratamentului de reconstructie in fracturile de gamba deschisede tip !I B, C!"#er"ta Nat!"a&a de Ort!'ede Trau$at!&!)e/ 12/ T$!ara/ 41(4?

Oct./ 199

9. Co%( D., A"se& L:./ Schart+er) R. 8$ seuential protocol for management of severe

open tibial fractures, C&"ca& Orth!'aedcs Z Re&ated Research/ -?150/ 6(12?/ 1995 :u"

12.Cor-u V./ Mc&e L/ Fara)! Gh./ S$ara"descu D. 8)ste fixatorul extern indicatia ideala

in tratamentul fracturilor deschise de gamba, C!"#er"ta Nat!"a&a de Ort!'ede

Trau$at!&!)e/ 11/ T$!ara/ 41(4? Oct./ 199

11.Cor-u V./ Mc&e L/ Fara)! Gh./ S$ara"descu D. 8(ambourile musculare pediculate in

tratamentul fracturilor deschise de gamba, C!"#er"ta Nat!"a&a de Ort!'ede

Trau$at!&!)e/ 14/ T$s!ara/ 41(4? Oct./ 19914.Co0a T. 8 *tabilization of the bone in open fractures, 4"d@a&Ba" Z thSOROT

C!")ress !# Orth!'aedcs/ 44/ Ia/ R!$a"a/ 42(44 Oct. 1999

1?.Co0a T., Cuc!s V./ Murarasu Ha&!&!r/ T!caru I 8 $titudinea noastra in tratamentul

fracturilor deschise tip !ide gamba, C!"#er"ta Nat!"a&s de Ort!'ede Trau$at!&!)e/

11/ T$s!ara/ 41(4? Oct./ 199

16.Co0a T., Ia"cu C/ Tra"da+at C/ A&e%a O./ Sar+u P./ C!rcac R./ Ge!r)escu N. 8 %ur

)xperience in the #anagement of *evere %pen /ibial *haft 8ractures, 4"d@a&Ba" Z th

SOROT C!")ress !# Orth!'aedcs/ 5/ Ia/ R!$a"a/ 42(44 Oct. 1999

15.David A., Oster$a"" PA./ M!&&e"h!## G/ He+e+ra"d D./ Muhr G. 8 Changes intherapeutic principles in fractures of the extremities Aith severe soft tissue in=uries

exemplified b? tibial fracture. Re*e 5?re#s/ e"tra&+&att #ur Chrur)e/ 144-0/ 1(9/

199;

1.Dic/son J.F., H!##$a" [\./ De&)ad! ED./ C!"treras DM. 8 0nreamed rod Aith earl?

Aound closure for grade III $ and IIIB open tibial fractures' anal?sis of consecutive

patients, Orth!'edcs -Th!r!#are/ N:0/ 41-50/ 5?1(5/199 Ma

1;.E&&%i S., Sch!&& E./ Herte& R. 8 #anagement of IIIB open tibial fractures b? earl?

osteos?nthesis and local muscle flap, U"#a&&chrur)/ 121-90/ ;6(?/ 199 Se'

1.En(scu 2., D!"ca I./ Lu'escu V./ A"dre T./ Ma"da P. 8 #anagementul fracturilor

grave de tibie cu a=utorul fixatorului Ilizarov, C!"#er"ta Nat!"a&s de Ort!'ede

Trau$at!&!)e/ 1;/ T$!ara/ 41(4? Oct./ 19919.)a0-a D., Che*a&&e F.8 /reatment b? external fixator of open


31/34

4?.)orunN.8$ccidentele rutiere in etiopatogenia fracturilor deschise, Re*. Ort!'. Trau$.

-SOROT0/ 4-4(?0/ ;1(;;/ 1994

46.)orunN./ Tr!a"escu O. 88ractura deschisa, Ed. Medca&a/ @ucurest 19;9

45.Has @./ :!*a"!*c S./ !"e ./ T!Ba&c M./ X!'c . 8$nal?sis of results of treatment of

open and unstable grade II and III fractures in the calf, L,ec"cB V,es"B./ 11-?(60/ 5;(

9/ 199 Mar(A'r4.Iovan(scu L., P!' A&./ @a,at A./ @a,at A"ca 8>articularitatile fracturii deschise de

gamba in treimea inferioara, C!"#er"ta Na]!"a&a de Ort!'ede s Trau$at!&!)e/ 42/

T$s!ara/ 41(4? Oct./ 199

4;.Jai @L/ \!B!a$a X./ Sh"d! M./ It!$a" M. 8>roblems of various fixation methods for

open tibia fractures' experience in a ;apanese level I trauma center, A$. :. !# Orth!'.

-Chatha$/ N:0/ 4;-90/ ?1(/ 199 Se'

4.Jindsfat(r J., :!"asse" EA. 8 %steom?elitis in grade II and III open tibia fractures

Aith late debridement, :. !# Orth!'. Trau$a. 9-40/ 141(;/ 1995 A'r

49.Lucaciu D. 8 0pdate on the @rug $dministration in the /reatment of %pen 8ractures,4"d@a&Ba" Z thSOROT C!")ress !# Orth!'aedcs/ 45/ Ias/ R!$a"a/ 42(44 Oct. 1999

?2.Lu1(scu OHv(ra 8 *pecial Characteristics of the /reatment of /?pe III %pen 8ractures,

4"d@a&Ba" Z thSOROT C!")ress !# Orth!'aedcs/ ?2/ Ias/ R!$a"a/ 42(44 Oct. 1999

?1.Lu1(scu O%iv(ra,Na)ea M/ Crstescu I./ Ncu&escu D. 8Internal vs )xternal 8ixation in

III$ - IIIB %pen 8ractures of the #edium /hird of the /ibial *haft, 4"d@a&Ba" Z th

SOROT C!")ress !# Orth!'aedcs/ ?/ Ias/ R!$a"a/ 42(44 Oct. 1999

?4.Lu1(scu O%iv(ra,Na)ea M/ Patru Crst"a 8 /ratamentul profilactic antitrombotic in

fracturile deschise ale gambei utilizdnd enoxaparina sodica "Clexane&, C!"#er"ta

Nat!"a&s de Ort!'ede s Trau$at!&!)e/ 42/ T$s!ara/ 41(4? Oct./ 199

??.Lu1(scu O%iv(ra, Na)ea M/ Patru Crst"a/ @ar+u D./ Ncu&escu D. 8 $titudineaterapeutica in fracturile deschise tip III ale gambei - sinteza centromedulard saufixator

extern , C!"#. Nat!"a&s de Ort!'ede Trau$at!&!)e/ 44/ Tu"s.!ara/ 41(4? Oct./ 199

?6.Lu1(scu @.8 /raumatologie - (uxatiile si fracturile membrelor, V!&.1/ ?(42/ 1(;4/ 4?(

495/ Fac. Medc"a C!"sta"ta/ 199

?5.Lu1(scu @., A"dre T./ E"escu M. 8 #anagement of *everal 8racture of the /ibia.

IlizarovDs )xternal 8ixation, HI C!")ress EFORT/ PO 4/ @arce&!"a 199;

?.2afi P. 8 *oft /issue 9econstruction of the (oAer )xtremities. 12 Eears )xperience in

Far In=ured >atients, SICOT/ Sd"e Austra&a/ 412/ 1(4? A'r& 1999

?;.2atiuta L/ Mercea I./ A"dras E./ H!ra" C/ Dac!"escu S. 8 )xperienta noastrd

privind fractura deschisa de gamba, C!"#er"ta Nat!"a&s de Ort!'ede Trau$at!&!)e/4?/ T$s!ara/ 41(4? Oct./ 199

?.2ar E./ @rau" [./ Ruter A. 8 Fhat are the advantages of 0/4 "unreamed tibial nail&

in open tibial fractures, e"tra&+&att #ur Chrur)e/ 142-90/ ;45(?2/ 1995

?9.2u-ara/ S. 8 /reatment of $cute Compartment *?ndromes, SICOT Sd"e/ 51/ 1(4?

A'r& 1999

62.2u-ara/ S./ Har)e"s A.R. 8$cute Compartment *?ndrome, Sur). C&". N!rth A$erca

?/5?9(55/19?

61.2u-ara/ S./ Oe" CH. 8 Compartmental *?ndrome and Its 9elation to the Crush


32/34

*?ndrome ' $ *pectrum of @isease, C&". Orth!'. a"d Re&ated Research "!.;(9/ 19;5

64.2u-ara/ S.:./ Har)e"s A.R./ Oe" C.A./ Garett! L.P./ ABes!" [.H. 8 /he Fic+

Catether /echniue for #easurement of Intramuscular >ressure, :. @!"eZ:!"t Sur)./

5(A/ 121/ 19;

6?.Natis X./ Tsa")ar!s G./ Ga*r&ds @./ X!u&a&s G=8 %pen tibial fractures treatment Aith

external fixation and secondar? reamed intramedular? nailing, 41stTre""a& [!r&dC!")ress SICOT/ 1(4? a'r&e 1999/ Sd"e Austra&a/ 44?

66.Nico%(scu 2., O,!)a L. 8$dvantages and @isadvantages of )xternal 8ixation for %pen

8ractures, 4"d@a&Ba" Z thSOROT C!")ress !# Orth!'aedcs/ 6/ Ias/ R!$a"a/ 42(44

Oct. 1999

?3. O-adaN. 8 *indroamele de compartimentposttraumatice ale gambei - teza de doctoral/

U.M.F. Car!& Da*&a/ @ucuret 1999

?".O-adaN. 8 *indromul compartimental posttraumatic al gambei ( consideratii clinice,

teoretice si practice, Re*. Ort!'ede Trau$at!&!)e -SOROT0/ 199/ -60/ 42?(411

?.O-ada N., @adarau I/ Or+ea"u V./ O+ada @. 8 /he /ibia %pen 8ractures and the

Compartment *?ndrome. Clinical Consideration. /herapeutic $ttitude., 41st

Tre""a&[!r&d C!")ress SICOT/ 1(4? a'r&e 1999/ Sd"e Austra&a/ 42

?+. O-adaN./ Lu'escu V. 8 Compartmental *?ndromes in the %pen 8ractures of the /ibia,

HI C!")ress !# the Eur!'ea" Federat!" !# Nat!"a& Ass!cat!" !# Orth!'aedcs a"d

Trau$at!&!) -EFORT0 ( @arce&!"a -S'a"a0/ 46(4; a'r&e 199;/ 129

?6.O-adaN./ Lu'escu V./ @adarau I. 8 /herapeutical Consideration in the /reatment of the

%pen /ibia 8ractures, 9unning the 9ise of Copartment *?ndrome, 6thC!")ress !# the

Eur!'ea" Federat!" !# Nat!"a& Ass!cat!" !# Orth!'aedc a"d Trau$at!&!) -EFORT0

@russe&s/ ?( :u"e 1999/ 11;

3!.O-adaN./ Lu'escu V./ @adarau I./ Or+ea"u V./ O+ada @. 8 >robleme terapeutice

privind tratamentul fracturilor deschise de gambd, S$'!!"u& cu te$a A 92(a

a"*ersare a S'ta&u&u de Ort!'ede E#!re Sud/ ?(6 dece$+re 199.

51 .O-ada N./ Mara"a Ma"escu 8 *indroamele de compartiment ale gambei dupa

traumatism. Corelatii clinice, presionale si histopatologice, Re*. Ort!'ede

Trau$at!&!)e -SOROT0/ 199;/ ;-10/ 9(;?

3.O-adaN./ Matara")a M./ @adarau I./ @!rdea"u I. 8$titudinea terapeutica infracturile

cominutive deschise de gambd, A& V&(&ea C!")res de Ort!'ede s Trau$at!&!)e cu

'artc'are "ter"at!"a&a/ 1/ 5(; !ct!$+re 1995 / C&u, Na'!ca

3>.O-adaN./ O+ada @. 8 /he %pen *han+ 8racture in the *urgical *trateg? of the Critical

>olitrauma. )tiopathological, Clinical and /herapeutical Considerations, ?rdEur!'ea"

C!")ress !# Trau$a a"d E$er)e"c Sur)er/ 15(1; Se't. 1999/ L!" Fra"ce/ 4

3?.O-ada N./ O+ada @./ @adarau I. 8 Clinical Implications of the >ressional Conflictdeveloped in the *han+ $natomic (ogges. >resent /herapeutical, Clinical and

>h?siopathological %utloo+, 5thC!")ress !# the Eur!'ea" Ass!cat!" !# C&"ca&

A"at!$/ 6thNat!"a& C!")ress !# the R!$a"a" S!cet !# A"at!$sts/ ?(5 u"e/ Ne'tu"

C!"sta"ta/ 161

55. Pa1i%ian V. 8$natomia omului, V!&.1/ 5(/ ?22(?14/ Ed. ddactca s 'eda)!)ca/

@ucuret 19;6

5.P(tr(scu P., Petrescu H./ Pre,+ea"u R/ @ercea"u M./ C!rca" A"ca 8 Conduita noastrd


33/34

terapeutica in rezolvarea fracturilor deschise de gambd negli=ate, C!"#er"ta Nat!"a&s de

Ort!'ede Trau$at!&!)e/ 4/ T$!ara/ 41(4? Oct./ 199

5;.Po1 AL 88ractura deschisa de tibie, U"*erst Press Vas&e G!&ds Arad 1999

5. Po1 A&.8(ocul actual al mioplastiei de acoperire in tratamentul fracturilor deschise de

gamba, Re*. Ort!'. Trau$. -SOROT0/ -1(40/ ?1(?6/ 199

59.Po1 A&. 8 /he #anagement of %pen 8ractures, 4"d@a&Ba" Z thSOROT C!")ress !#Orth!'aedcs/ ?5/ Ias,/ R!$a"a/ 42(44 Oct. 1999

2.Po1 AL/ Tar"au A./ I!*a"escu I./ Gu)u&a" D./ Fru,a D. 8 /herapeutic >roblems in the

#anagement of %pen /ibial 8ractures, 4"d @a&Ba" Z th SOROT C!")ress !#

Orth!'aedcs/ / Ias/ R!$a"a/ 42(44 Oct. 1999

1. Po1 AL/ Tar"au A./ Tr!ca" I./ Gu)u&a" D./ Petrca M. 8 %steosinteza in fracturile

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