Наукові праці. Кафедра судової медицини, медичного правознавства імені заслуженого професора М.С. Бокаріуса
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Item Features of mechanical injuries of the lower extremities according to a forensic medical examination: a retrospective analysis(2020) Sokol, Viacheslav; Sokol, Kostyantin; Kolesnichenko, ViraThe aim: To study the structure of lower extremities’ mechanical injuries and the reasons for an additional (commission) forensic medical examination appointment, according to a retrospective analysis. Materials and methods: research protocols were116 reports of additional (commission) forensic medical examinations of victims with mechanical trauma to lower extremities; research methods – retrospective analysis, statistical method. Reports of forensic medical commission examination were selected by random sampling, for the period February – June 2018. Results: As a result of a retrospective analysis of commission (additional) forensic medical examination, the prevalence of road traffic injuries (109; 94.0% cases) in mechanical injuries of the lower extremities was established. Domestic (5; 4.2%), work (1; 0.9%) and sports (1; 0.9%) injuries were also indicated It was found that to establish the degree of permanent disability loss according to the outcome of fractures of the femur and shin bones, commission examinations were appointed in 24.1% of cases. The main reason for the commission examinations appointment was to establish the bodily injuries presence (6.9%), as well as to establish the bodily injuries presence and their severity (62.9%) in cases of road traffic injury (lethal and non-lethal). Conclusions: The use of commission forensic medical examination is mainly related to the criminal law criteria of the preliminary investigation stage. The reason for conducting commission examinations on medical criteria is to establish the outcome of a fracture of the lower limb.Item Method of forensic assessment of risk factors of treatment failure outcomes as an element of quality management of medical care(2020) Sokol, Viacheslav; Kolesnichenko, Vira; Sokol, Kostyantin; Smiianov, VladyslavThe aim: The aim of this research was to study causes of the development of adverse outcomes in isolated femоral diaphyseal fractures. Materials and methods: A retrospective analysis of the protocols of clinical and radiological examination of 21 patients was performed. Based on the initial expert assessment, these patients have not been established the severity of injuries due to the development of complications in the postoperative period. Conclusions: Patient-dependent, implant-dependent, and surgery-dependent causes that caused a violation of the stability of osteosynthesis (95.2%) were identified. This led to a secondary displacement of bone fragments (71.4%), delayed fracture consolidation (61.9%), the formation of pseudarthrosis (38.1%), the development of post-traumatic osteomyelitis (14,3), migration of screws from the osseous plate (47.6%), and the development of post-traumatic contracture of the knee joint (81.0%).Item Structure of long bone fractures of lower limbs at a car injury(2020) Sokol, ViacheslavThe most traumatized body region in road traffic accidents is the lower extremities, however, the structure of fractures has not been adequately studied. Objective: to study the structure of long bones fractures of the lower extremities in various nonlethal car injuries. Material and methods. The research material was 116 reports of primary forensic medical examinations of victims with fractures of the femur and/or shin bones resulting from a car injury. When studying the frequency of damage to various areas of the body and the frequency of fractures of long bones of the lower extremities, it was taken into account that 28 victims with polytrauma had multiple injuries, and thus 116 patients revealed 232 injuries of various areas of the body and 138 fractures of long bones of the lower legs. Research methods — retrospective analysis, descriptive statistics. Results. The main contingent of those injuries in the car accident was car drivers (8.5%) and pedestrians (47.3 %) aged 31–50 years. In the general group, the shin (37.9 %), thigh (21.6 %), head (13.8 %) were most injured areas, in the group of car drivers — neck, thigh, chest, shin, in the group of passengers — head, shin and thigh; pedestrians — shin, thigh, head. Due to the predominance of anterior (41.4 %) and anterolateral collisions of a moving car in the group as a whole, in cases of the of pedestrians injuries as well as in cases of in-cabin injuries, the presence of bumper fractures of the lower leg bones, as well as fractures of the femur of various localization, was observed. Conclusions. According to the initial forensic medical examination, a collision of a moving car with a pedestrian (78.4 %) and a collision of moving vehicles (21.6 %) were observed in the structure of non-lethal car accidents. In this case, diaphyseal fractures of the femur (29.8 %) and the shin bones (47.1 %) in the general group and in the group of pedestrians (20.4 and 40.7 %, respectively) predominated. Fractures of the femur of various localization were most often detected also in the in-cabin injuries (50.0 % of the total number of fractures in drivers and passengers).