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Current forms of medical reports cannot be used for clinical and epidemiological and medical and economic researches because they don't contain information about competitive, associated diseases and its complications. Authors developed the method of clinical and epidemiological monitoring of nosologic structure of patients in military-medical institutions based on personalized record-keeping of patients with additional informational resources for recording of all diagnoses and performed medical service. With the help of the given method were analyzed nosologic structure and treatment results of 548 patients with vehicular trauma from the 442nd District Military Clinical Hospital. Polytrauma was revealed in 22% of patients, concomitant injury--in 39%, combined injures--in 0.4%. Besides, in 8% of patients were revealed associated chronic diseases that not only confound trauma, but also make difficult to diagnose and assess the severity of trauma.

The terminology of the battle mechanical damages has a direct connection with determination of frequency and structure of such damages and value of sanitary loss. The entitled figures are necessary for troop basis during the medical treatment. The present article is written because of appearance in large academic and research works of military-medical directionality inadequate and incorrect data of frequency of damages by the similar wounds. It is caused by the false methodological approach to the usage of this terminology and requires the valid correction of results of such works.

For the period from 2004 till 2009 142 patients were observed in our clinic. We were able to follow up 53 of the 74 patients in the main group and 49 of the 68 ones in the control group for 12 months. The majority of injuries were located in the front area of foot; most of them were dislocation fractures. It was shown that the frequency of isolated stable and unstable traumas was roughly equal. Multiple injuries were generally unstable. We designed a simple convenient classification of fractures and dislocation fractures in front and middle parts of the foot. An original algorithm is proposed for the treatment and choice of operating methods based on our classification and ensuring satisfactory results in the majority of cases. Relief incisions outside projection of the surgical intervention field make it possible to close the operating wounds and avoid extension of their edges, prevent enlargement of edema, and avoid severe pyoinfectious complications in the early postoperative period. Overall, we achieved reduction of their frequency to 1% compared with 10% in the control group. The frequency of late complications was 9.44% versus 42.85% in controls.

The analysis of a medico-social characteristic of victims with multiple injuries in Omsk revealed the nature of multiple and associated injuries distribution among socially-adapted and socially-disadapted groups of population. The top place was taken by multiple injuries received as a result of road accidents. The sections of population most open to multiple injuries were determined. The age peculiarity of such injuries, the accompanying diseases influencing the nature of injury received and the future prognosis in victims were identified.

The application of scores for the assessment of injury severity allows a decision on the optimal strategy of treatment of patients with multiple and associated traumas at all stages of trauma disease. The correct choice of time, method and volume of surgery allows minimization of complications associated with the operative aggression on the one hand, and forced adynamia and asthenic syndrome on the other hand.

The outcomes of treatment of 386 victims with abdominal trauma and fractures of the long tubular bones were studied. The authors systematized the typical complications developing after the trauma, both on the part of the injured organs of the abdominal cavity and true pelvis and the fractures of the long tubular bones. This allowed the developed complications to be divided according to time into early, late, and sequelae of trauma. The early complications of injuries to the organs of the abdomen and true pelvis are as follows: suppuration of postoperative wounds, postoperative wound dehiscence with or without eventration, recurrent intracavitary hemorrhage, progressing local peritonitis, incompetence of anastomoses, intestinal obstruction, abdominal abscesses and infiltrates, abscesses and infiltrates in the true pelvis, intestinal paresis, large hematomas, phlegmons of the anterior abdominal wall. The late complications are: sluggish wounds of the anterior abdominal wall, formation of ligature fistulas, postoperative ventral hernias, suppuration of intraorganic and interstitial hematomas, subclinical forms of sepsis and sepsis, thrombophlebitic complications, chronic venous insufficiency, persistent wounds, and other complications. The sequelae of injury to the organs of the abdominal cavity and true pelvis are: intestinal fistulas, functional intestinal disorders, gastric disease, the dumping syndrome, cicatricial changes of the anterior abdominal wall, posttraumatic disease, venous insufficiency, pneumosclerosis, chronic pneumonia, pulmonary emphysema, chronic vascular insufficiency, etc. The early complications in fractures of long tubular bones in the group of studied patients: suppuration of osteomuscular wounds, recurrent displacement of bone fragments, bone necrosis in open type IIIC, IIID fractures, gangrene of the limb consequent upon crushing of skin and subcutaneous tissue, subluxations, secondary subluxations of limbs.(ABSTRACT TRUNCATED AT 250 WORDS)

ENT injuries totaled up to 1.4% from all other wounds. As for localization of wounds the most frequent were neck injuries (53%). Wounds of nose or accessory sinus of nose comprised 45.6%, and ear wounds--1.4%, 5.8% of wounded needed emergency care, 45.8%--secondary surgical care, and 48.4%--tertiary surgical care. The article analyses the errors of medical care, and gives the classification of ENT injuries.

The present-day classification of gunshot penetrating abdominal wounds has a several number of limitations, namely: sometimes it is difficult to classify correctly the gravity of wounds, thus patients with different gravity status frequently form the same group of wounded. The authors propose to concretize the existing classification. A new variant will provide for a straight definition between the groups, the wounded who belong to the same group could be comparable in their gravity status. Generally, this new classification give a more complete and precise notion concerning the character of modern gunshot penetrating abdominal injuries.

Results of emergency laparoscopies in 240 patients with closed traumas of the abdomen are presented. No injuries were found in 154 patients when performing laparoscopy. By the authors' data the diagnostic informative value of laparoscopy in closed traumas made up 98%. Wide use of laparoscopy allowed to avoid diagnostic laparotomy in doubtful clinical picture of closed abdominal traumas.

Based upon the 20-years experience of the clinic of field surgery of the Military Medical Academy with treatment of critical mechanical injuries the authors propose to differentiate concepts "injury" and "trauma" and hence the ideas of "severity of injury", "severity of the state" and "severity of trauma". It is expedient to use concepts of "isolated", "multiple", "associated" traumas instead of non concrete ideas of "polytrauma" which is correct but for determination of critical associated traumas. Definitions of such concepts as "consequences of trauma" and "complications of trauma", "trauma disease" and "trauma shock" are given.

The authors observed and helped 157 patients with multiple trauma of the chest. Trauma shock was observed in 97 of them. A clinical classification of such injuries is proposed. Main combinations of injuries of internal organs have been found. Surgical tactics is considered.

The authors have substantiated the necessity of elaboration and introduction of a single all-state++ system of objective quantitative evaluation of the severity of the injuries. A brief comparative characteristic of the most popular Soviet and foreign systems of the severity of the injuries is presented. The synthesized scales (elaborated at the prognosis laboratory of the Central Institute of Traumatology and Orthopedics ) for a quantitative evaluation of the character and the localization of the fractures are presented.