[Optimization of rehabilitation of elderly and senile patients with primary traumatic dislocation of the shoulder.].

Тhe aim of the study is to improve the treatment outcomes of elderly patients with primary traumatic shoulder dislocation by developing an atraumatic rehabilitation method. The study included 56 patients aged over 60 years with primary traumatic dislocation of the shoulder. The patients of the first group (29 patients) after the dislocation of the shoulder was corrected, functional treatment was performed using orthoses and a developed course of physical therapy.

[Optimization of trauma care to victims of older age groups with fractures of the proximal femur.].

The objective of the study was to improve the treatment outcome of patients of older age groups with fractures of the proximal femur by developing an algorithm for providing medical care while taking into account the nature of a fracture and the comorbid background of a patient. The article describes approaches to the choice of tactics and techniques of medical assistance to patients of older age groups with fractures of the proximal femur. 4 491 patients with fractures of the proximal femur who had been treated at the Hospital for War Veterans in Saint Petersburg from 2010 to 2019 were included for analysis.

NEW TECHNOLOGIES IN TREATMENT OF FRACTURES OF THE UPPER EXTREMITIES IN PATIENTS WITH SEVERE MULTIPLE AND POLYTRAUMA.

A comparative analysis of treatment results of fractures of long bones of the upper extremities was made in 172 victims with severe polytrauma. The traditional strategy of treatment was used in the first group. The new technologies such as prognostic tactics, method of Damage control orthopedics and low-invasive osteosynthesis developed by the authors were applied in the second group.

[Assessment of medical care quality in craniocerebral trauma on the base of data analysis].

An analysis of 658 medical records of inpatient treatment from 15 hospitals of St.Petersburg was made using a computer-aided technology of the assessment of medical care quality. It was revealed that a proper quality of medical care in craniocerebral trauma was only in 52.

[The srategy of programed multistage surgical treatment ("damage control surgery") of neurotrauma].

A retrospective analysis of diagnostics and surgical treatment was made in 440 patients with polytrauma, who were on the treatment in hospitals in Saint-Petersburg, Syktyvkar and Omsk during 2009-2012. The neurotrauma was the dominating damage. The patients were divided into two groups: the main and the control group, using the equal quantitative ratio according to the sex, age, circumstances of trauma and type of damages.

[Principles of early rehabilitation of the neurotrauma].

The retrospective analysis of surgical and rehabilitation treatment of 172 patients with neurotrauma was made. The patients were treated in Russian Polenov Neurosurgical Institute and Municipal hospital of St. Elizabeth in the period since 2009 till 2012.

[Infectious complications of polytraumas: microbiological and epidemiological aspects].

The authors discuss problems of terminology and definition of terms associated with surgery of injuries, polytrauma and a conception of wound dystrophy. Great statistical material (about 5000 casualties with polytrauma) was used to show the structure and frequency of infectious complications of severe associated injuries systematized according to the original classification of this pathology. The classification is based on a universal pathophysiological process developing in response to any extraordinary influence--a systemic inflammatory response.

[C-reactive protein in severe combined trauma not complicated and complicated by sepsis].

The role of C-reactive protein (CRP) was studied in the development of nonbacterial systemic inflammation response, infectious complications, severe sepsis in severe combined trauma. It was shown that daily quantitative indicators of CRP in blood of patients in the intensive care unit allowed prognosis of the development of nonbacterial systemic inflammation response, infectious complications and sepsis. The CRP level >40 mg/l in the first day under conditions of not using glucocorticoids manifests a risk of the development of infectious complications.

[Pathogenetical peculiarities of the first period of trauma disease in acute heart failure].

Under observation there were 29 casualties with severe combined trauma complicated by acute heart failure (AGF) caused by a direct injury of the heart, without severely disturbed consciousness and valuable blood loss. In 65% of the patients the trauma was severe, in 35%--extremely severe. Higher ST wave was registered in ECG of 40% of the patients in standard leads, in 30% there was no wave R in chest leads.

[Organization and contents of the specialized surgical care in multiprofile military hospitals of the 1st level during counter-terrorist operations on the northern Caucasus (report V)].

The principle difference of the work of multiprofile military hospitals (MMH) of the Ist level during the armed conflicts on the Northern Caucasus, particularly during the second, was rendering specialized surgical care to the primary contingent of the wounded, evacuated during the nearest hours after a wound. The incoming flow to MMH of the 1st level - in connection with the primary entering of the wounded practically from a battle field - was characterized by severity (one third of the wounded had severe and extremely severe wounds) and the significant number of the wounded with multiple and combined injuries (up to 60% of the wounded). Effective treatment of the above-mentioned wounded can only be carried by specially trained surgeons in appropriately-equipped multiprofile medical hospitals.

[Surgical care rendered to the wounded during the antiterrorist operations in the Northern Caucasus in the distant medical battalions of divisions. (Communication 3)].

Broad usage of helicopters for an evacuation of wounded from the battle orders and forward aid station directly to Multiprophyle Military Hospitals of 1-st level during armed conflicts on Northern Caucasus has essentially changed the purposes and nature of a medical care to wounded in Separate Medical Battalions (SMB) of divisions. The primary goal of SMB became valuable preparedness of wounded to an evacuation from the battle orders of a division, that was reached by moving out of the surgeons and anesthesiologists to regimental aid station and medical companies. For adding up during armed conflicts on Northern Caucasus of medico tactical conditions it was justified: 73% wounded, admitted in SMB with damages of minimal and mean severity and not required emergency operations, after rendering them of initial physician care were evacuated by helicopters to Multiprophyle Military Hospitals of 1-st level.

[An anesthesiologist-resuscitator's differential tactics in acute traumatic disease].

The detection of four forms of the course of acute traumatic disease (traumatic shock, acute respiratory failure, acute heart failure, and traumatic coma) leads to the conclusion that the multi pathogenic mechanism responsible for progression of the disease generates a need for differentiating the tactics of an anesthesiologist-resuscitator, beginning from the first hours after injury. Therapeutic tactics may be standardized within each specific form of an acute period of traumatic disease. Implementation of specific tactic programs for anesthesiological and resuscitative care in acute traumatic disease has promoted a reduction in mortality from 8.

[Pathogenetical features of the first period of trauma disease with acute respiratory insufficiency].

The pathogenetical features of acute respiratory insufficiency (ARI) were studied as a clinical form of the first period of the trauma disease (TD)--the period of acute impairments of the important for life functions (the first 8-12 h after trauma). In 17 casualties with a severe combined trauma the severity of the first period of the disease depended on the ARI caused by a serious injury of the chest not accompanied by a direct injury of the heart. It was shown that ARI is an independent clinical form of the first period of TD.

[Surgical care rendered to the wounded in the antiterrorist operations on the Northern Caucasus: premedical and initial medical care in the combat zone (Report II)].

The analysis of organization and contents of the first aid, premedical and initial medical care rendered to the wounded in the armed conflicts on the Northern Caucasus (1994-1996, 1999-2002) was conducted. It was established that the first aid was rendered to the most casualties who needed it (65% in the first conflict and 79% in the second conflict). The mean terms of rendering the first aid in the second conflict as compared with the conflict of 1994-1996 were decreased from 29 +/- 2 min to 18 +/- min.

[Pathogenetical features of the acute period of traumatic disease. Traumatic shock as a special manifestation of the acute period].

Clinico-pathogenetical features of the acute period of trauma disease due to a severe combined injury were studied in 644 patients. An analysis of clinical indices was made in 428 of them, clinico-laboratory indices--in 216 patients. The results have shown that the main form of the acute period of the trauma disease are traumatic shock (62.

[Principles of surgical care organization and structural characteristics of sanitary casualties in counter-terrorist operations in the Northern Caucasus (Report I)].

Two operational-and-tactical factors had the main influence on organization of the surgical care rendered to the casualties on the Northern Caucasus: the fulminant and maneuverable nature of combat operations at the beginning of both armed conflicts and rather small territory of war theatre. The main special features of organization of surgical care to the casualties were the use of Medical Squads of Special Purpose in the combat conditions and maximal approximation of the specialized surgical care to the wounded by echelonment of medical units and wide use of helicopter evacuation. The structure of sanitary losses was characterized by the increase in the frequency of mechanical traumas, thermal and combined injuries, by the high share of the casualties with head injuries.

[The severe combined cerebro-cranial trauma. Pathobiochemical characterization].

The indices of the endocrine system, systemic transport and consumption of oxygen, metabolism, hemostasis in the femoral artery, central and internal jugular veins were investigated in 144 patients with severe combined cerebro-cranial traumas (CCT) during the first 7 days after trauma. In 15 of them liquor was investigated. The results of the investigation have shown that in not severe CCT (FS-II: 0.

[Application of superoxide dismutase preparation for the prophylaxis of post-traumatic broncho-pulmonary complications].

The effectiveness of endobronchial application of superoxide dismutase (SOD) for prevention of posttraumatic bronchopulmonary complications was analyzed in 11 patients with severe combined traumas and dominating injuries of the chest. It was shown that severe combined traumas sharply initiate processes of free radical oxidation in tissues, intensify prooxidative activity, deplete total antioxidative activity and its important link--plasma and erythrocyte SOD. Endobronchial instillation of SOD after a severe combined trauma results in increased intracellular activity of catalase, total antioxidative activity, SOD, decreased production of lipid peroxides in homogenate of the pellet of bronchoalveolar lavage (BAL), reduced number of neutrophiles and higher number of lymphocytes in BAL pellet.

[Problems of prehospital care for a severe combined trauma].

The authors have analyzed the strategy and results of treatment of 455 casualties at the prehospital stage. Main defects of giving help at the prehospital stage and ways to improve it are described.