PubMed · 471465
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V I Karasev. 1979. [Removable compression plate].. https://pubmed.ncbi.nlm.nih.gov/471465/
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The article addresses the pathophysiological aspects connected to multiple trauma leading to organ damage. Several studies have shown that early operative stabilization of fractures is a lifesaving treatment involving less pulmonary complications, a shorter stay in hospital and lower hospital costs than operation at a late stage. The author also discusses guidelines for diagnosis and primary treatment of the fractures, and the timing and tactics of the final operative treatment. When the patient has been stabilized and injuries with higher priority (thoracic, abdominal and head injuries) have been successfully treated, it is recommended to operate major fractures as soon as possible (within 24 hours). It is necessary to have a liberal attitude to early operative treatment of minor fractures and injuries to ligaments, since these injuries might otherwise immobilize the patient and reduce the potential for physical restitution. The treatment of multi-traumatized patients imposes demands for extensive skills and experience, not only on the part of surgeons and anaesthetists, but also among the whole trauma team, including nurses in the operating theatre, anaesthetist nurses and nurses in the intensive care unit. This means that care of multi-traumatized patients should be centralized to experienced trauma units.
Owing to the continuous turnover of registrars and radiographers, most of the trauma-related orthopaedic surgery in this academic hospital is done by inexperienced surgeons-in-training and the fluoroscopy by junior radiographers. This could result in excessive radiation doses. Calibrated lithium fluoride thermoluminescent chips were secured to various parts of the primary surgeon's body to quantify the radiation dose received during the insertion of an intramedullary nail. Closed intramedullary fixation of 15 fractures of the femur was done with interlocking as necessary. The total average exposure time was 14 minutes 45 seconds per procedure. Distal locking took up 31% of this time. The mean radiation dose to the surgeon's eyes and thyroid was 0.13 mGy and to the dominant hand 2.10 mGy. This would allow the performance of about 350 such procedures per year before the maximum permissible dose level was reached. Recommendations to decrease irradiation dosage are made.
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