Affiliation:
1. UKRAINIAN SCIENTIFIC AND PRACTICAL CENTRE OF EMERGENCY AND DISASTER MEDICINE MINISTRY OF HEALTH OF UKRAINE, KYIV, UKRAINE
2. I. HORBACHEVSKYY TERNOPIL NATIONAL MEDICAL UNIVERSITY, TERNOPIL, UKRAINE
Abstract
The aim: Identification, verification and analysis of clinically effective risks of limb amputation as a basis for the formation of risk-oriented treatment and diagnostic tactics in victims with limb injuries due to modern hostilities.
Materials and methods: This research is based on a study of 1,072 cases of limb damage due to modern hostilities in eastern Ukraine in 2014-2020. All injuries were gunshot (bullet and mine injuries). According to the concept of Clinical Risk Management, Clinical Result Risk was chosen for evaluation and analysis. Risk factors - epidemiological and anatomical signs of damage.
Results: Quantitative indicators of the clinical effective risk of limb loss are generally small and range from minimal to significant values (0.01-0.24). In some cases - up to 0.4 (significant), and are not critical and catastrophic. Of practical importance are only the risk factors associated with the nature of participation in hostilities and the anatomical characteristics of the injury. Among the immediate causes of limb loss, only primary traumatic amputation matters. Damage to vascular and nerve structures is not critical for limb loss. The impact of other risk factors may be reduced or eliminated if adequate care is provided.
Conclusions: The risks of limb loss in victims of modern hostilities vary within the qualitative characteristics of the minimum-significant risk. The greatest importance in the clinical implementation of risks are risk factors related to the performance of functional duties of servicemen and anatomical features. he use of risk-based analysis must be taken into account in the formation of standards of medical care and treatment protocols for victims of modern hostilities.
Reference14 articles.
1. 1. Bailey C.J.A., Morrison M.J.J., Rasmussen C.T.E. Military trauma system in Afghanistan: lessons for civil systems, Curr Opin Crit Care. 2013; 19(6): 569-577.
2. 2. Belmont P.J.Jr., McCriskin B.J., Sieg R.N. Epidemiology of combat wounds in operation Iraqi freedom and operation enduring freedom: orthopaedic burden of disease. J Surg Orthop Adv. 2010; 19(1): 2-7.
3. 3. Schoenfeld A.J., Dunn J.C., Bader J.O., Belmont P.J.Jr. The nature and extent of war injuries sustained by combat specialty personnel killed and wounded in Afghanistan and Iraq, 2003-2011. J Trauma Acute Care Surg. 2013; 75(2): 287-291.
4. 4. Emergency war surgery: fourth United States revision. Department of defense United States of America. 2013, 588 p.
5. 5. Belmont P.J., McCriskin B.J., Hsiao M.S. et al. The Nature and Incidence of Musculoskeletal Combat Wounds in Iraq and Afghanistan (2005– 2009). J. Orthop. Trauma. 2013; 27: 107–113.