Evaluation of the Functional Outcome of Polytrauma Patients with Musculoskeletal Injuries. Summary of the Doctoral Thesis

Abstract

A significant number of patients with multiple injuries is registered every year in Latvia. Functional recovery of patients after polytrauma is a long-term process. Functional results of these patients depend not only on trauma severity and mechanisms, but also on the early treatment of the injuries, diagnozed during primary survey, definitive treatment and early rehabilitation.The teams who treat polytrauma patients in the hospitals, often do not receive the information abaut functional result. The aim of the study is to analyze the functional result of polytrauma patients with consequences of lower limb injuries. To achieve the aim retrospective study of 154 polytrauma patients (101 male, 53 female; New injury severity score (NISS) 17–48, mean 25.9), who suffered from musculoskeletal injuries in the Riga Eastern Clinical University Hospital, Clinic „Gailezers”, Trauma and Orthopaedic Department and Hospital of Traumatology and Orthopaedics during 2008–2010 year period, was performed. Evaluation of functional outcomes of the 34 study group patients, who corresponded the inclusion criteria, in the medium-term (1–3 years) after polytrauma was performed in the Rīga Stradiņš University Rehabilitation Faculty Rehabilitation Research Laboratory, located in the National Rehabilitation Centre “Vaivari”. Definitions of the gait cycle kinematic and kinetic parameters used in our study and the range of normal gait parameters were determined. Gait deviations (GD) severity was determined in our study. In the evaluation of the functional outcomes the patient´s complaints, clinical, radiological examination and three dimensional instrumental gait analysis (IGA) were included. The protocols of orthopaedic examination and gait record analysis were worked out and filled. The gait record analysis was performed and conclusions were made. The GD severity was assessed and recommendations for further rehabilitation and improvement of functional outcome were worked out. The analysis of clinical examination and IGA data collection of 34 healthy volunteers of the control group was performed. The GD severity was analyzed in the follow-up after polytrauma with orthopaedic injuries in the order of the polytrauma severity, using Injury severity score (ISS) and NISS, connection of NISS and GD severity was calculated. Gait cycle parameters in polytrauma patients group were compared with the gait parameters in the control group of the same lower extremity. Using IGA we found, that compensatory pathological changes during the gait were also in the uninjured side. Therefore the early complex rehabilitation of patients after polytrauma with injuries of lower limb should be performed including the prophylactic rehabilitation of the uninjured side. We found that patients with lower limb injuries, who had NISS more than ISS, had a more severe GD and we propose this fact for the prognosis of the functional result.