Sokol V. K., Tonkoy D. V., Kozhushko I. A.

FORENSIC MEDICINE

Scentific article

The aim is to carry out a comparative analysis of the severity of bodily injuries in victims with fractures of the femur and tibia in the immediate post-traumatic period and in the outcome of trauma based on a retrospective study of acts of primary and commissioned forensic medical examinations. Object and research methods. The injury outcome was assessed in victims with 49 fractures of the femur and 112 fractures of the tibia, presented in 185 reports of commissioned forensic medical examinations for the period February-June 2018. Results of the work. Open fractures of the femur and tibia are classified as serious injuries regardless of the outcome of the injury. All closed fractures of the femoral shaft (40; 24.8%), as well as 70 (43.5%) fractures of the shaft and 7 (4.4%) intraarticular fractures of the tibia, were attributed to moderate bodily injuries. According to the trauma outcomes, 2 (1.3%) closed diaphyseal fractures of the tibia (development of chronic post-traumatic osteomyelitis, unresolved bone shortening and deformity) were reclassified as severe bodily injuries. All 5 (3.1%) intraarticular fractures of the femur and 10 (6.3%) – the tibia, treated conservatively, were re-qualified as severe bodily injuries as a result of a non-fused subcapital femoral fracture (1; 0.6%), post-traumatic arthrosis of the hip (1; 0.6%), knee (11; 6.8%) and ankle (2; 1.2%) joints with persistent contractures, pronounced limitation of the function of the joint and the act of walking. The field of application is forensic medicine, traumatology and orthopaedics. Conclusions. Conservative treatment of displaced intra-articular fractures of the lower extremities is a significant risk factor for an unfavorable outcome of injury and aggravating the severity of injuries. The lack of unification of open fractures of the femur and tibia in the provided medical documentation according to generally accepted classifications did not allow assessing the outcomes of the studied open fractures.

fracture of the femur, fracture of the tibia, severity of bodily injuries, forensic medical examination.

1. Pravyla sudovo-medychnoho vyznachennia stupenia tiazhkosti tilesnykh ushkodzhen. Zatverdzheno nakazom Ministerstva okhorony zdorovia Ukrainy vid 17.01.95 № 6. [in Ukrainian].
2. Fracture and Dislocation Compendium – 2018. J Orthop Trauma. 2018;32(1):4-106. DOI: 10.1097/BOT.000000000000106
3. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Jt Surg Am. 1976;58(4):453-8.
4. Kryterii vstanovlennia stupenia stiikoi vtraty profesiinoi pratsezdatnosti u vidsotkakh, osoblyvostei pratsevlashtuvannia khvorykh ta invalidiv. Zatverdzheno nakazom Ministerstva okhorony zdorovia Ukrainy vid 05.08.98 № 212. [in Ukrainian].
5. Fracture and dislocation compendium. Association Committee for Coding and Classification. J Orthop Trauma. 1996;10 Suppl 1:v-ix:1-154.
6. A new classification scheme for open fractures. Orthopaedic Trauma Association: Open Fracture Study Group. J Orthop Trauma. 2010;24:457-64. DOI: 10.1097/BOT.0b013e3181c7cb6b
7. Krettek C, Helfet DL. Fractures of the distal femur. In: Browner B, Levine A, Jupiter J, Trafton P, Krettek C. Skeletal Trauma, 4th ed., II. Amsterdam: Elsevier; 2008; p. 1957-2011.
8. Denisiuk M, Afsari A. Femoral Shaft Fractures. Stat Pearls [Internet]. Stat Pearls Publishing; Treasure Island (FL): March 14, 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556057/
9. van de Ree CLP, De Jongh MAC, Peeters CMM, de Munter L, Roukema JA, Gosens T. Hip Fractures in Elderly People: Surgery or No Surgery? A Systematic Review and Meta-Analysis. Geriatric Orthopaedic Surgery & Rehabilitation. 2017;8(3):173-80. Available from: https://doi.org/10.1177/2151458517713821
10. Ghosh S, Adak S, Chaudhuri A, Datta S, Roy DS, Chaudhuri SK. Management of closed isolated tibial shaft fracture: A dilemma in a rural set up of a developing country. Med J DY Patil Univ. 2014;7:738-43. DOI: 10.4103/0975-2870.144863
11. Lin CA, Swiontkowski M, Bhandari M, Walter SD, Schewitsh EH, Sanders D, et al. Reaming Does Not Affect Functional Outcomes After Open and Closed Tibial Shaft Fractures: The Results of a Randomized Controlled Trial. J Orthop Trauma. 2016;30(3):142-8. DOI: 10.1097/ BOT.0000000000000497
12. Giordano V, Giordano M, Gloria RC, de Souza FS, di Tullio P, Lages M, Koch HA. General principles for treatment of femoral head fractures. J Clin Orthop Trauma. 2019;10(1):155-60. DOI: 10.1016/j.jcot.2017.07.013
13. Coon MS, Best BJ. Distal Femur Fractures. Stat Pearls [Internet]. Stat Pearls Publishing; Treasure Island (FL): Aug 8, 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551675/
14. Berven H, Brix M, Izadpanah K, Kubosch EJ, Schmal H. Comparing case-control study for treatment of proximal tibia fractures with a complete metaphyseal component in two centers with different distinct strategies: fixation with Ilizarov frame or locking plates. J Orthop Surg Res. 2018;13:121. Available from: https://doi.org/10.1186/s13018-018-0792-3
15. Wenger D, Petersson K, Rogmark C. Patient-related outcomes after proximal tibial fractures. International Orthopaedics (SICOT). 2018;42:2925-31. Available from: https://doi.org/10.1007/s00264-018-3920-0
16. Wright DJ, Bariteau JT, Hsu AR. Advances in the Surgical Management of Ankle Fractures. Foot & Ankle Orthop. 2019;4(4):1-11. Available from: https://doi.org/10.1177/ 2473011419888505
17. Skou ST, Juhl CB, Hare KB, Lohmander LS, Roos EM. Surgical or non-surgical treatment of traumatic skeletal fractures in adults: systematic review and meta-analysis of benefits and harms. Systematic Reviews. ВМС. 2020;9:179. Available from: https://doi.org/10.1186/ s13643-020-01424-4

«Bulletin of problems biology and medicine» Issue 4 (158), 2020 year, 379-384 pages, index UDK 340.66:617.58-001

10.29254/2077-4214-2020-4-158-379-384