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For the first time in the Georgian medical field, the results of surgical treatment of polytrauma victims were studied in the research using ETC (early total care) and DCO (orthopedic damage control) strategies. The issue of osteosynthesis during damage to long tubular bones and internal organs and the general and local complications accompanying this aggression are analyzed. The topic is relevant, since polytrauma is the main cause of death of the population, next to cardiovascular and oncological diseases and it is on the first place in the structure of lethality of people aged 18-42. The study was based on the results of observation of 365 patients who were treated and died in traumatological, surgical and critical medicine departments of Kutaisi Referral Hospital with a diagnosis of severe polytrauma. It is concluded that in the process of surgical treatment of injuries of the musculoskeletal system during polytrauma, when using both ETC (early total care) and DCO (orthopedic damage control) strategies, there is a slight difference in the frequency of general and local complications. It is not possible to assert the clear advantage of any of the mentioned strategies. Regardless of the level of development of traumatology, the number of general and local complications remains high when using both strategies. The rate of lethality during polytrauma is high, which is due not only to the general unpredictable condition of patients, shock, concomitant diseases and age, but also to the imperfect implementation of the ITLS system in the primary medical care system. It is recommended to conduct meta-analysis and other prospective studies in order to develop a national guideline for the treatment of polytrauma and to create a national trauma registry based on the experience of European countries. [ABSTRACT FROM AUTHOR]

The review presents the results of experimental and clinical studies of the effect of early osteosynthesis in the femoral fracture on the development of systemic complications and the outcome of polytrauma with chest injuries. We explored the role of combination of thoracic injuries with a fracture of the femur, as well as its intramedullary osteosynthesis in the mechanisms of local and systemic inflammatory reaction formation, coagulopathy, fatty embolism and pulmonary embolism, respiratory failure. The concepts of “immediate total care” and “orthopedic damage control” are described with reference to fractures of the femur, combined with a chest trauma. The criteria for the relative safety of osteosynthesis of the femur in polytrauma with thoracic injuries are given.

We demonstrate the peculiarities of diagnosis and successful multi-stage treatment of a patient with severe combined trauma and heart rupture complicated by extensive ischemic stroke in early postoperative period. A patient with severe combined injury was treated at the trauma center grade 3 (State Clinical Hospital No. 25, Volgograd) in 2023. We should remember Beck's triad and possible sternum fracture as a marker of severe chest injury for timely diagnosis of heart rupture with pericardial tamponade. Successful multi-stage treatment of a patient with severe combined trauma and cardiac rupture complicated by extensive ischemic stroke in early postoperative period was demonstrated.