Features of the organization of traumatological care in the regions of the Russian Federation (a scientific review)

Authors:

Shcherbak Nikolay Petrovich, MD, traumatologist-orthopedist, Leninskaya Central District Hospital, 33a Yastrebova Street, 404621 Leninsk, Volgograd Region, Russian Federation, e-mail: shcherbak@ya.ru

Mansurov Djalolidin Shamsidinovich, PhD in Medical sciences, MD, orthopedist, North-Western State Medical University named after I.I. Mechnikov, 41 Kirochnaya Street, 191015 St. Petersburg, Russian Federation, e-mail: jalolmedic511@gmail.com

Dorofeev Yuri Leonidovich, PhD in Medical sciences, Ava-Peter LLC, Scandinavia Clinic, 4/1 Ilyushina Street, 197372 St. Petersburg, Russian Federation, e-mail: dorofeev76@list.ru

Khaydarov Valery Mikhailovich, PhD in Medical sciences, senior lab technician of the Department of traumatology, orthopedics and military field surgery, North-Western State Medical University named after I.I. Mechnikov, 41 Kirochnaya Street, 191015 St. Petersburg, Russian Federation, e-mail: drxaydarov@mail.ru

Tkachenko Alexandr Nikolaevich, Grand PhD in Medical sciences, Professor, Professor of the Department of traumatology, orthopedics and military field surgery, North-Western State Medical University named after I.I. Mechnikov, 41 Kirochnaya Street, 191015 St. Petersburg, Russian Federation, phone: +7-911-215-19-72, e-mail: altkachenko@mail.ru

Annotation:

Introduction. The frequency of road-related and industrial injuries in Russia and other developed countries remains high. The working-age population injuries most frequently. At the same time, despite the undeniable progress and achievements of traumatology in recent years, the treatment outcomes for injured are not always satisfactory. Special role in positive results of treatment of patients with skeletal trauma belongs to a medical care organization.

Aim. The aim of this work is the analysis of features organization of trauma service in different regions of the Russian Federation.

Results. The concept of medical care for patients with injuries (including fractures of bones) implies special centers of four levels. In most cases, the 1st level traumatology centers are located in the administrative center of the region. This level is the main organizational and methodological unit for traumatology centers of lower (2nd-4th) levels. In leading centers of the 1st level it is possible to provide all types of specialized medical care for injured, including so called high-technology care.
In international and Russian publications the quality of treatment has been considered during a long period of time. At the same time the regions of the Russian Federation are so different. They differ in area, population density, geographic and climatic condition, volume of financing, quality and availability specialized traumatology care. All this makes a significant organizational component in the work of the trauma service in each of the subjects of the Russian Federation.

List of cited literature:

1. Tihilov RM, Belen’kij IG, Kutyanov DI. Sovremennoe sostoyanie problemy ispol’zovaniya vnutrennego osteosinteza pri lechenii postradavshih s perelomami dlinnyh kostej konechnostej v usloviyah gorodskogo mnogoprofil’nogo stacionara rossijskogo megapolisa [The current state of the problem of the use of internal osteosynthesis in the treatment of victims with fractures of the long bones of the extremities in the conditions of the urban multidisciplinary hospital of the Russian metropolis]. Travmatologiya i ortopediya Rossii. [Traumatology and Orthopedics of Russia]. 2012;4:17-25. (In Russian).

2. Mironov SP, Es’kin NA, Ochkurenko AA. Sostoyanie travmatologo-ortopedicheskoj pomoshchi naseleniyu Rossii [The state of traumatological and orthopedic assistance to the population of Russia]. X yubilejnyj Vserossijskij s»ezd travmatologov-ortopedov. [X jubilee All-Russian Congress of Traumatologists-orthopedists.] M.: «Chelovek i zdorov’e», 2014. S. 3. (In Russian).

3. Cleveland KB. General principles of infection. Campbell’s operative orthopaedics. 12-th ed. Philadelphia: Elsevier, 2013. 706-23.

4. Cook GE, Markel DC, Ren W, Lawrence X, Webb LX, McKee MD, Schemitsch EH. Infection in Orthopaedics. J. Orthop. Trauma. 2015;29(12):19-23. DOI: 10.1097/BOT.0000000000000461.

5. Githens M, Haller J, Agel J, Firoozabadi R. Does concurrent tibial intramedullary nailing and fibular fixation increase rates of tibial nonunion? A matched cohort study. J. Orthop. Trauma. 2017;31(6):316-20. doi: 10.1097/BOT.0000000000000832.

6. Miromanov AM, Trubicyn MV, Mironova OB, Miromanova NA. Personalizirovannye aspekty razvitiya vospalitel’nyh oslozhnenij pri perelomah kostej konechnostej [Personalized aspects of the development of inflammatory complications in fractures of the bones of the extremities]. Politravma [Polytrauma]. 2017;2:37-41. (In Russian).

7. Kanakaris N, Gudipati S, Tosounidis T, Harwood P, Britten S, Giannoudis PV. The treatment of intramedullary osteomyelitis of the femur and tibia using the Reamer-Irrigator-Aspirator system and antibiotic cement rods. J. Bone Joint Surg. 2014;96-B(6):783-8. doi: 10.1302/0301-620X.96B6.32244.

8. Gumanenko EK, Hromov AA, CHapurin VA, Ekhsan-Ul’-Hak. Iskhody hirurgicheskogo lecheniya perelomov dlinnyh trubchatyh kostej u postradavshih s politravmami [Outcomes of surgical treatment of fractures of long tubular bones in victims with polytrauma] Sovremennye problemy nauki i obrazovaniya [Modern problems of science and education]. 2016;3:196. (In Russian).

9. Starodubov VI, Sidorov KV, Zarubina TV, Alepko AA. Formirovanie integral’nyh pokazatelej ocenki urovnya informatizacii medicinskoj organizacii [Formation of integral indicators for assessing the level of informatization of a medical organization]. Vrach i informacionnye tekhnologii [Doctor and information technologies]. 2018;1:6-24. (In Russian).

10. Shevchenko LA. Specifika i tendencii proizvodstvennogo travmatizma i professional’nyh zabolevanij rabotnikov organizacij Kemerovskoj oblasti [Specifics and trends of industrial injuries and occupational diseases of employees of organizations of the Kemerovo region]. Vestnik Kemerovskogo gos. un-ta. Seriya: Biologich., tekhnich. nauki i nauki o Zemle. [Bulletin of the Kemerovo State University. Series: Biological, technical sciences and Earth Sciences]. 2017;3:65-7. (In Russian).

11. Shchepin VO, Shishkin EV. Rol’ travm, otravlenij i nekotoryh drugih posledstvij vozdejstviya vneshnih prichin v smertnosti naseleniya Rossijskoj Federacii. [The role of injuries, poisoning and some other consequences of external causes in the mortality of the population of the Russian Federation] Menedzher zdravoohraneniya. [Health care manager]. 2018;6:18-24. (In Russian).

12. Mironov SP, Ochkurenko AA, Ochkurenko NV, Perminov VA. Ob»edinyaya travmatologo-ortopedicheskuyu sluzhbu nashej strany [Uniting the traumatological and orthopedic service of our country]. Vestnik travmatologii i ortopedii im. N.N.Priorova. [Bulletin of Traumatology and Orthopedics named after N.N.Priorov]. 2021;28(1):7-15Hernigou J, Schuind F. Smoking as a predictor of negative outcome in diaphyseal fracture healing. Int. Orthop. 2013;37(5):883-7. DOI: 10.1007/s00264-013-1809-5. (In Russian).

13. Hernigou J, Schuind F. Smoking as a predictor of negative outcome in diaphyseal fracture healing. Int. Orthop. 2013;37(5):883-7. DOI: 10.1007/s00264-013-1809-5.

14. Firsov SA. Principy prognozirovaniya i monitoringa sostoyaniya v sisteme okazaniya medicinskoj pomoshchi postradavshim v chrezvychajnyh situaciyah na primere dorozhnotransportnogo travmatizma [Principles of forecasting and monitoring of the state in the system of providing medical care to victims in emergency situations on the example of road traffic injuries] Mir nauki, kul’tury, obrazovaniya. [The world of science, culture, and education]. 2014;6:596-8. (In Russian).

15. Sirazitdinov SD, Pankov IO. Sovershenstvovanie metodov diagnostiki i profilaktiki rannih oslozhnenij travmaticheskoj bolezni pri mnozhestvennyh perelomah kostej konechnostej [Improving methods of diagnosis and prevention of early complications of traumatic disease in multiple fractures of the bones of the extremities]. Kafedra travmatologii i ortopedii. [Department of Traumatology and Orthopedics]. 2016;1:36-9. (In Russian).

16. Sir M, Pleva L, Prochazka V. Multiple trauma – treatment of skeletal injuries with damage control orthopedics. Rozhl. Chir. 2014;93(5):287-91.

17. Andreeva TM, Ogryzko EV, Popova MM. Travmatizm, ortopedicheskaya zabolevaemost’, sostoyanie travmatologo-ortopedicheskoj pomoshchi naseleniyu Rossii [Traumatism, orthopedic morbidity, state of traumatological and orthopedic assistance to the population of Russia]. Min. Zdravoohraneniya Rossii, FGBU «CITO im. N.N.Priorova». Moscwa, 2014. 132 p. (In Russian).

18. Prikaz Ministerstva zdravoohraneniya RF ot 24.12.2012. № 1384n «Ob utverzhdenii standarta skoroj medicinskoj pomoshchi pri travme konechnostej i (ili) taza» [Order of the Ministry of Health of the Russian Federation of December 24, 2012 No. 1384n «On approval of the standard of emergency medical care for injuries of the extremities and (or) the pelvis»]. Access mode: http://
base.garant.ru/70321002. – Title from the screen. (In Russian).

19. Prikaz Ministerstva zdravoohraneniya RF ot 9.11.2012. № 884n «Ob utverzhdenii standarta pervichnoj mediko-sanitarnoj pomoshchi pri perelome tela (diafiza) plechevoj kosti» [Order of the Ministry of Health of the Russian Federation of November 9, 2012 No. 884n «On approval of the standard of primary health care for the fracture of the body (diaphysis) of the humerus»] [Electronic resource]. – Access mode: http://base.garant. ru/70304596. – Title from the screen. (In Russian).

20. Prikaz Ministerstva zdravoohraneniya RF ot 9.11.2012 g. № 885n «Ob utverzhdenii standarta pervichnoj mediko-sanitarnoj pomoshchi pri perelomah tel (diafizov) loktevoj i luchevoj kostej» [Order of the Ministry of Health of the Russian Federation of November 9, 2012 No. 885n «On approval of the standard of primary health care for fractures of the bodies (diaphysis) of the ulna and radius»]. [Electronic resource]. – Access mode: http://base.garant.ru/70347230. – Title from the screen. (In Russian).

21. Skoroglyadov AV, Lyadova MV. Problemy standartizacii pri mediko-ekspertnoj ocenke kachestva okazaniya pomoshchi postradavshim s sochetannoj i mnozhestvennoj travmoj [Problems of standardization in the medical expert assessment of the quality of assistance to victims with combined and multiple trauma] Kafedra travmatologii i ortopedii. [Department of Traumatology and Orthopedics]. 2016;2:30-3. (In Russian).

22. Lapshinov EB, Luchkevich VS, Linnik SA, Shakirov AM. Organizacionnye formy i effektivnost’ vysokotekhnologichnogo lecheniya patologii kostno-myshechnoj sistemy [Organizational forms and efficiency of high-tech treatment of pathology of the musculoskeletal system] St. Petersburg: Karo-Neva. 2012. 151 p. (In Russian).

23. Es’kin NA, Andreeva TM. Sostoyanie specializirovannoj travmatologo-ortopedicheskoj pomoshchi v Rossijskoj Federacii [The state of specialized traumatological and orthopedic care in the Russian Federation]. Vestnik travmatologii i ortopedii im. N.N.Priorova. [Bulletin of Traumatology and Orthopedics named after N.N.Priorov]. 2017;1:5-11. (In Russian).

24. Fang C, Wong T, Lau T, To K Wong SS, Leung F. Infection after fracture osteosynthesis — Part I: Pathogenesis, diagnosis and classification. J. Orthop. Surg. 2017;25(1):1-13. DOI: 10.1177/2309499017692712.

25. Hellebrekers P, Leenen LP, Hoekstra M, Hietbrink F. Effect of a standardized treatment regime for infection after osteosynthesis. J. Orthop. Surg. Res. 2017;12(1):41. DOI: 10.1186/s13018-017-0535-x.

26. Romano CL, Morelli I, Romano D, Meani E, Drago L. ICS classification system of infected osteosynthesis: Long-term results. Injury. 2018;49(3):564-9. DOI: 10.1016/j.injury.2018.01.002.

27. Dielwart C, Harmer L, Thompson J, Seymour R, Karunakar M. Management of closed diaphyseal humerus fractures in patients with injury severity score >17. J. Orthop. Trauma. 2017;31(4):220-4. DOI: 10.1097/BOT.000000000000076.

28. Ippolitov IYu, Kistkin AI, Shirokov II. Rezul’taty ispol’zovaniya blokiruyushchego osteosinteza pri perelomah dlinnyh trubchatyh kostej v urgentnoj travmatologii [Results of the use of blocking osteosynthesis in fractures of long tubular bones in urgent traumatology]. Nauchnyj al’manah. [Scientific almanac]. 2016;6/2 (20):351-7. (In Russian).

29. Galstyan RS, Petrosyan HM. Problemy stabil’nogo osteosinteza pri perelomah dlinnyh trubchatyh kostej [Problems of stable osteosynthesis in fractures of long tubular bones] Voprosy klinicheskoj i teoreticheskoj mediciny. [Questions of clinical and theoretical medicine]. 2012;5:35-7. (In Russian).

30. Egiazaryan KA, Cherkasov SN, Attaeva LZh. Analiz struktury pervichnoj zabolevaemosti po klassu travmy, otravleniya i nekotorye drugie posledstviya vozdejstviya vneshnih prichin vzroslogo naseleniya Rossijskoj Federacii [Analysis of the structure of primary morbidity by class of trauma, poisoning and some other consequences of external causes of the adult population of the Russian Federation] Kafedra travmatologii i ortopedii. [Department of Traumatology and Orthopedics]. 2017;1:25-7. (In Russian).

31. Castoldi F, Blonna D, Assom M. Simple and complex fractures of the humerus. Roma: Springer; 2015. 213-48.

32. Reznik LB, Borzunov DYu, Mohovikov DS, Stasenko IV. Opyt zameshcheniya defektov dlinnyh kostej na osnove sochetannogo primeneniya vneochagovogo chreskostnogo osteosinteza i osteokonduktivnyh materialov v klinicheskoj praktike [Experience in the replacement of long bone defects based on the combined use of extra-focal transosseous osteosynthesis and osteoconductive materials in clinical practice]. Politravma [Polytrauma]. 2017;2:16-22. (In Russian).

33. Panov AA, Kopysova VA, Kaplun VA, Petrushin EG, Caj DA. Rezul’taty osteosinteza oskol’chatyh perelomov dlinnyh trubchatyh kostej [Results of osteosynthesis of comminuted fractures of long tubular bones]. Genij ortopedii. [Genius of orthopedics]. 2015;4:10-6. DOI: 10.18019/1028-4427-2015-4-10-16. (In Russian).

34. Ee WWG, Lau WLJ, Yeo W, Bing YV, Yue WM. Does minimally invasive surgery have a lower risk of surgical site infections compared with open spinal surgery? Clin. Orthop. Relat. Res. 2014;472(12):1718-24. DOI: 10.1007/s11999-013-3158-5.

35. Liu B, Xion Y, Deng H, Gu S, Jia F, Li Q, Wang D, Gan X, Liu W. Comparison of our self-designed rotary self-locking intramedullary nail and interlocking intramedullary nail in the treatment of long bone fractures. J. Orthop. Surg. Res. 2014;9:47. DOI: 10.1186/1749-799X-9-47.

36. Palmer CW, Jones CI, Park DK. Postoperative infections of the spine. Seminars in Spine Surgery. 2016;28(3):134-42.

37. Mears SC, Edwards PK. Bone and joint infections in older adults. Clin. Geriatr. Med.2oi6;32(3):555-7O. DOI: 10.1016/j.cger.2016.02.003.

38. Rozova LV, Godovyh NV. Sravnitel’naya harakteristika vidovogo sostava mikroorganizmov pri hronicheskom posttravmaticheskom i gematogennom osteomielite [Comparative characteristics of the species composition of microorganisms in chronic posttraumatic and hematogenic osteomyelitis.] Genij Ortopedii. [The Genius of Orthopedics]. 2014;2:56-9. (In Russian).

39. Tkachenko AN, Ekhsan-Ul’-Hak, Korneenkov AA, Kushnirchuk II, Rankov MM, Hromov AA, Bojchenko AV. Prognoz infekcionnyh oslozhnenij v zone operacii pri metalloosteosinteze dlinnyh trubchatyh kostej [Prognosis of infectious complications in the area of surgery during metallosteosynthesis of long tubular bones]. Politravma [Polytrauma]. 2018;1:17-25. (In Russian).

40. Saleh H, Driesman A, Fisher N, Leucht P, Konda S, Egol K. Social to moderate alcohol consumption provides a protective effect for functional outcomes after fixation of orthopaedic fractures. J. Orthop. Trauma. 2017;31(6): e173-e8. DOI: 10.1097/BOT.0000000000000831

41. Medvedev DA. Ob osnovah ohrany zdorov’ya grazhdan v Rossijskoj Federacii [On the basics of protecting the health of citizens in the Russian Federation]: Federal’nyj zakon ot 21 nojabrja 2011 g. № 323-FZ [Federal Law No. 323-FZ of November 21, 2011]. Rossiyskaya Gazeta [Russian Newspaper]. 2011. November 23. №5639. (In Russian).

42. Ob utverzhdenii Poryadka okazaniya medicinskoj pomoshchi postradavshim s sochetannymi, mnozhestvennymi i izolirovannymi travmami, soprovozhdayushchimisya shokom: Prikaz Ministerstva zdravoohraneniya RF ot 15 noyabrya 2012 g. №927n [On approval of the Procedure for providing medical care to victims with combined, multiple and isolated injuries accompanied by shock: Order of the Ministry of Health of the Russian Federation of November 15, 2012 No. 927n] [Electronic resource]. – Access mode: ww.consultant. ru/document/cons_doc_LAW_142010/. – Blank from the screen. (In Russian).

43. Inozemcev EO, Grigor’ev EG, Aparcin KA. Aktual’nye voprosy hirurgii sochetannyh povrezhdenij (po materialam publikacij zhurnala «Politravma») [Actual issues of surgery of combined injuries (based on the materials of publications of the journal «Polytrauma»)]. Politravma. [Polytrauma]. 2017;1:6-11. (In Russian).

44. Agadzhanyan VV. 25 let GAUZ KO «Oblastnoj klinicheskij centr ohrany zdorov’ya shahterov» [25 years GAU KO «Regional clinical center of health protection of miners»]. Politravma [Polytrauma]. 2018;2:6-10. (In Russian).

45. Gumanenko EK, Shcherbuk YuA, Silyuk MG, Golovko KP, Madaj OD, Udal’cova NA, Gorshkov EA, Bumaj AO, Afinogenova AG, Afinogenov GE, Madaj DYu. Biometricheskie aspekty lecheniya sochetannoj travmy [Biometric aspects of combined trauma treatment] Vestnik hirurgii im. I.I. Grekova. [Bulletin of Surgery named after I.I.Grekov]. 2018;177(3):25-30. (In Russian).

46. Soong C, Cram P, Chezar K, Tajammal F, Exconde K, Matelski J, Sinha SK, Abrams HB, Fan-Lun C, Fabbruzzo-Cota C, Backstein D, Bell CM. Impact of an integrated hip fracture inpatient program on length of stay and costs. J. Orthop. Trauma. 2016;30(12):647-52. DOI: 10.1097/BOT.0000000000000691.

47. Westgeest J, Weber D, Dulai SK, Bergman JW, Buckley R, Beaupre LA. Factors associated with development of nonunion or delayed healing after an open long bone fracture: A prospective cohort study of 736 subjects. J. Orthop. Trauma. 2016;30(3):149-55. DOI: 10.1097/BOT.0000000000000488.

48. Van den Berg, Osei D, Boyer MI, Gardner MJ, Ricci WM, Spraggs-Hughes A, McAndrew MC. Open tibia shaft fractures and soft-tissue coverage: the effects of management by an orthopaedic microsurgical team. J. Orthop. Trauma. 2017;31(6):339-44. DOI: 10.1097/BOT.0000000000000815

49. D’Alleyrand JC, O’Toole RV. The evolution of damage control orthopedics: current evidence and practical applications of early appropriate care // Orthop. Clin. North Am. 2013;44(4): 499-507. DOI: 10.1016/j.ocl.2013.06.004.

50. Harwood PJ, Giannoudis PV, Probst C, Krettek C, Pape HC. The risk of local infective complications after damage control procedures for femoral shaft fracture. J. Orthop. Trauma. 2006;20(3):181-9. DOI: 10.1097/00005131-200603000-00004.

51. Danilov MA, Borozda IV. Lechenie bol’nyh s razryvami akromial’no-klyuchichnogo sochleneniya modelirovannoj spicej i kortikal’nym vintom [Treatment of patients with ruptures of the acromioclavicular joint with a simulated spoke and a cortical screw] Vestnik travmatologii i ortopedii im. N.N.Priorova. [Bulletin of Traumatology and Orthopedics named after N.N.Priorov]. 2015;2:43-9. (In Russian).

52. Voronin NI, Borozda IV. Dinamika sochetannyh travm taza v Amurskoj oblasti [Dynamics of combined pelvic injuries in the Amur region] Dal’nevostochnyj medicinskij zhurnal. [Far Eastern Medical Journal]. 2009;1:27-9. (In Russian).

53. Korobicyn AP, Korobicyna AA. Struktura telesnyh povrezhdenij v Arhangel’skoj oblasti [The structure of bodily injuries in the Arkhangelsk region]. Actual problems of military and extreme medicine. IV Internet Conference with internat. participation. 2016;20-31. (In Russian).

54. Tkachenko AN, Dorofeev YuL. Osobennosti organizacii travmatologicheskoj pomoshchi v regione s sezonno
nestabil’noj chislennost’yu naseleniya [Features of the organization of trauma care in a region with a seasonally unstable population]. III Vseros. congr. from the international. participation «Medical care for injuries of peace and wartime. New in the organization and technologies»: St. Petersburg: Publishing House «Man and his health», 2018;273-5. (In Russian).

55. Bohl DD. Basques BA., Golinvaux NS., Baumgaertner MR., Grauer JN. Nationwide inpatient sample and national surgical quality improvement program give different results in hip fracture studies. Clin. Orthop. Relat. Res. 2014;472(6):1672-80. DOI: 10.1007/s11999-014-3559-0.

56. Kalashnikov AV, Vdovichenko KV, CHalajdyuk TP. Struktura operativnyh vmeshatel’stv pri lechenii diafizarnyh perelomov dlinnyh kostej nizhnej konechnosti v 2008 g. [The structure of surgical interventions in the treatment of diaphyseal fractures of the long bones of the lower limb in 2008.] Travma [Trauma]. 2011;12(2):127-31. (In Russian).