Optimizing the prevention of infectious and inflammatory complications after osteosynthesis of long-bone fractures of the lower extremities

Objective: To reduce the number of infectious complications after osteosynthesis of long bones by developing and implementing new preventive measures. Material and Methods: The results of surgical treatment of 110 patients with fractures of long bones of the lower extremities were analyzed. The patients were divided into the main (n=51) and control (n=59) groups. The severity of injury in victims upon admission was assessed using the Injury Severity Score (ISS). In parallel with emergency care, all patients underwent diagnostic procedures in the intensive care unit of the emergency room: general clinical laboratory tests, assessment of comorbid status, monitoring of the functions of vital organs, hemodynamic parameters, level of consciousness, respiratory function, and circulating blood volume. Results: Stratification of patients by traumatic injury severity revealed a similar distribution in the two groups. Mild injury severity was recorded in 60.8% and 62.7% of patients, respectively, and accounted for the majority of injuries in both cohorts. Severe injuries were recorded at a rate of 17.6% and 13.5%, respectively, while critical conditions on admission were found in 7.8% and 8.5% of cases, respectively. Considering the severity of the injury, a surgical treatment algorithm was developed. Of the 21 (41.2%) injured in the main group, the severity of injuries was assessed as severe in 13 (25.5%) according to the ISS. The surgical was delayed until the normalization of inflammatory markers and vital functions. The remaining patients were operated on at the optimal time, taking into account all indicators. Conclusion: Prevention of wound infection after osteosynthesis of long bones of the lower extremities requires a multimodal approach, considering a combination of clinical, anamnestic, and intraoperative determinants. The scope of preventive measures is determined by the initial severity of the patient’s condition, the nature and morphology of bone and soft tissue injuries, the patient’s age and premorbid medical history, including comorbidities, the extent of perioperative blood loss, the presence and severity of organ dysfunction, the timing of surgery from the time of injury, and the chosen osteosynthesis method.

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