Fracture fixation strategy: experience and recommendations

Abstract

The commentary critically analyzes the strategy proposed by the authors of the article for performing osteosynthesis and describes the system of care for patients with fractures in Moscow. Operating rooms are divided into planned and emergency. And they, in turn, are divided into conventional and hybrid, in which it is simultaneously possible to perform endoscopic, endovascular, and open surgery. Surgeries are performed in order of priority. Highest priority: extra-focal fixation of limb bones and/or pelvis with ex-fix devices; surgery on extremities with impaired blood supply in the distal parts; decompressive fasciotomies with simultaneous external fixation of fragments in ex-fix devices with suspected formation of compartment syndrome; surgeries performed in patients with severe combined or multiple trauma. High priority: open fractures of type 3A and 3B according to the Gustillo classification, requiring primary surgical treatment of wounds and external fixation; closed unstable fractures.

Keywords

• osteosynthesis
• emergency trauma care
• healthcare organization