Epidemiology and statistics of uncomplicated compression fractures of the spine in children. What is spinal cord injury

Statistics
The frequency of spinal injury is about 1000 people per 10 million people per year. Of these, 70% are injuries of the thoracolumbar spine. About 3% of them remain profoundly disabled.
Description
The thoracic region consists of 12 vertebrae. From the bodies of the vertebrae on each side depart the ribs, which are connected in front to the sternum. This part of the spinal column is less mobile compared to the cervical and lumbar spine. Below is the lumbar region, consisting of 5 vertebrae. It carries the greatest load on the entire spinal column. If you look at the spinal column from the side, you can see that in shape it resembles a spring, where one bend smoothly passes into another. This is necessary for better balance and even load distribution. In the thoracolumbar region, between the 11th thoracic vertebra and the 2nd lumbar thoracic kyphosis turns into lumbar lordosis and the vertical load axis passes through the vertebral bodies. This explains the fact that in spinal injuries, the greatest number of injuries occur in this zone. The upper thoracic and lower lumbar regions are affected much less frequently. Exceptions are compression fractures of the vertebral bodies in osteoporosis, when the thoracic spine suffers more.
Mechanisms and causes of injury
A spinal fracture is a high-energy injury, meaning it requires a lot of force to occur. The most common causes are road traffic injuries and falls from a height. Fractures of the spine almost always occur not due to a direct impact on the fracture site (with the exception of gunshot fractures), but due to an indirect effect on the spine as a whole. Depending on the nature and direction of the force, damage occurs due to a sharp compression of the spine along the axis (falling from a height onto the legs or buttocks), flexion (hitting a passenger on the back of the front seat), extension (hitting a pedestrian from behind), stretching (getting into moving mechanisms) and twisting (motorcycle injury). It is also possible to shift the vertebrae and a combination of all these mechanisms.
Types of spinal injuries
Based on the mechanism of injury, one or another type of fracture occurs. The modern international classification proposed in 1994 by Magerl divided all injuries into three groups: A - injuries of the vertebral bodies as a result of compression along the axis of the spine; B - damage resulting from flexion - extension; C - includes injuries of the two previous groups in combination with vertebral shift and rotation. Depending on the volume and characteristics of damage within groups, damage is divided into three more types. This classification gives the doctor an idea of ​​the stability or instability of the damage and determines the features of treatment in each case.
Diagnostics
First of all, the patient should be carefully examined for the presence of neurological symptoms and identification of the area of ​​the alleged injury. Due to the fact that the clinical picture does not always correspond to the volume of damage, the first step is to perform survey radiographs. In severe injuries (traffic, fall from a height, train injury), an X-ray examination of the entire spine is necessary, because due to the severity of the condition, the patient cannot always clearly indicate the source of pain. The second stage, when a damaged vertebra (or several) is detected, is performed multispiral computed tomography, thanks to which it is possible to draw a conclusion about the nature of bone damage, displacement by fragments and stability of the damage. Magnetic resonance imaging can give an additional idea of ​​damage to the soft tissue structures of the spine - ligaments, intervertebral discs, spinal cord. But if there is no MRI scanner in the hospital, then it is not advisable to transport a patient with a spinal fracture to another institution for MRI. Shifting, transportation is very dangerous in unstable fractures and can lead to irreversible neurological damage due to mixing of fragments and compression of the nervous tissue.
Treatment
Stable uncomplicated vertebral body compression fractures with anterior height reduction of up to 50% are treated conservatively. It is recommended to wear an orthopedic corset for 4-6 months. In some cases, if the patient wants a quick recovery without prolonged external fixation, options for surgical treatment using minimally invasive technologies may be considered. All complicated and unstable fractures are subject to surgical treatment. Depending on the nature of the injury and the type of fracture, various options for surgical interventions are used. The general principle of surgical treatment is to eliminate compression of the spinal cord and nerve roots, restore the correct axis of the spine, create the necessary conditions for fracture consolidation and securely fix the damaged spinal segment. We use the most modern fixators, we strive to avoid large incisions and traumatic operations as much as possible, we widely use microsurgical techniques and endoscopy.

The spine is the main component of the musculoskeletal system and provides the possibility of a vertical body position. Therefore, injuries of the spine and spinal cord can have a significant impact on the state of the whole organism. Various spinal injuries on average account for about 10% of the total number of back injuries. Damage is quite common in people of the older age group, regardless of gender. Young children also sometimes have spinal injuries, but as a rule, these are mainly injuries of the cervical spine and are associated with damage during childbirth. Female spinal injury has become much less common in recent years, as the number of women undergoing caesarean section has increased. Treatment of spinal injuries depends on the severity of the injury and the clinical picture and can be either surgical or conservative.

The reasons

The most common spinal injuries are caused by excessively heavy loads and impacts on the spinal column. This can include falls, reckless diving, accidents and traffic accidents. Sometimes the type of spinal injury can be determined by the nature of the physical effects. For example, in car accidents, trauma to the cervical spine most often occurs, while when falling from a height, fractures of the sacrum, lumbar or lower thoracic region occur. Spinal cord injuries can have various origins.

As a rule, in adults, spinal cord injuries occur due to the impact of external influences on different parts of the spine.

Damage associated with degeneration (osteochondrosis, spondyloarthrosis) can lead to the development of spinal stenosis. The narrowing of the spinal canal can lead to an impact on the nerve roots and spinal cord and, as a result, a violation of their functionality. Severe injuries often result from too much or sudden stretching of the spinal cord.

In cases of spinal cord injury, extremely serious disorders of the musculoskeletal system occur.

Types of spinal injuries

Signs of spinal injury depend on its type and nature. The types of damage that can occur are bruises, lacerations, fractures, dislocations, and compression.

Types of injuries directly affect the tactics of treatment and rehabilitation, as well as the consequences and speed of recovery of the patient.

• A fracture of the vertebrae in the cervical spine is a violation of the integrity of the bones, in contrast to the dislocation, which is characterized by displacement of the vertebrae relative to the axis. Such injuries of the vertebrae can lead to compression effects on the spinal cord. Compression fractures occur due to the impact of an excessive axial load vector on the vertebral body and, in this case, part of the vertebra moves forward and down. Thus, it is also possible to shift the intervertebral discs and bulge them into the spinal canal. These fractures are most common in car accidents or a sudden jerk of the body forward.
• When dislocation occurs, a rupture or severe stretching of the ligaments occurs. Such damage can displace and block the vertebrae. Thus, problems with the spinal cord may occur depending on whether the torn ligament was mobile. To restore the functionality of the vertebrae, the patient may need surgery.
• Paraplegia occurs due to damage to the lower part of the thoracic spine.
• Quadriplegia also occurs due to trauma, in which the cervical and upper thoracic spine are damaged. These spinal injuries lead to loss of mobility in all limbs.

Features of trauma of the cervical spine

The cervical spine is very sensitive to injury. According to statistics, cervical injuries account for 20% of all spinal injuries, more than 35% of them are fatal. Damage to the cervical spine is due to the fact that with a sharp blow, the head and torso of a person move in opposite directions.

Cervical spine injuries are very serious and dangerous conditions. Whiplash is the most common type of injury known. Usually this injury occurs to drivers or passengers during a car accident. During a sudden stop of the car, due to inertia, a sharp push is transmitted to all people in the cabin. As a rule, such an injury is accompanied by such symptoms as acute pain, a sharp restriction of neck mobility, dizziness or loss of consciousness.

Spinal injuries in the thoracic and lumbar regions

Quite often, various types of injuries are exposed to the thoracic and lumbar regions. The most common are fractures that occur during a fall or car accident. In addition, the risk of damage to these areas is high in the elderly due to age-related osteoporosis. Severe vertebral fractures can damage the spinal cord.

When the thoracic spine is injured, a person experiences back pain that can be moderate to severe and worsens with movement.

If the injury causes damage to the spinal cord, then symptoms such as numbness, muscle weakness in the limbs, and impaired bowel and bladder control may be added to the pain manifestations.

The most common injuries in the thoracic and lumbar spine are:

• Stretching of the intervertebral joints. This injury occurs when the vertebrae are forced forward or backward. The pain increases with flexion and extension of the body.
• Muscle rupture is a common back injury in athletes, as sudden movements can damage the muscle corset. Symptoms of a muscle tear include sharp pain when bending, extending, or rotating the torso.
• Dislocations of the musculoskeletal joints occur as a result of a forceful displacement of the vertebrae in the thoracic region or as a result of arthritis. With dislocation, the pain increases with coughing, sneezing, deep chest breathing.
• Fractures are very common in sports, falls or accidents. The pain syndrome persists for a long time and appears even with a slight turn of the body.
• Scoliosis or other spinal deformities are also serious injuries of the spinal column. Symptoms do not always appear and may vary from case to case.

Congenital spinal injuries

As a rule, problems with the spine in children are associated with a birth injury of the cervical spine. Birth injury of the cervical spine occurs in 40% of cases and is often accompanied by traumatic brain injury. The causes of such an injury may be the following circumstances:

• discrepancy between the size of the fetal head and the mother's pelvis;
• incorrect location of the fetus in the uterus;
• large fetus (weighing more than 4500 g);
• premature pregnancy;
• oligohydramnios (oligohydramnios) and other congenital conditions.

After an injury to the cervical spine, children may experience problems with academic performance, memory impairment, and it is difficult for them to concentrate on a subject.

Also, children may have a congenital anomaly Spina bifida, in which a child is born with spina bifida, due to which the vertebrae do not completely cover the nerve structures. Often such a defect occurs in the lumbosacral region, but it can also be in other departments.

Despite the severity of the injury, Spina bifida in children usually has a favorable prognosis if it is localized in the lumbosacral region.

During the growth period, the child may not experience back discomfort, but parents should monitor his diet and weight. Weight gain causes pressure on the unformed vertebrae, which can lead to symptoms. Sometimes spina bifida can lead to muscle weakness, paralysis, and other orthopedic problems.

Spinal cord injury

Sometimes a spinal injury extends to the spinal cord. This may be due to external factors such as a severe bruise or compression fracture of the cervical spine, although damage can occur anywhere in the spine.

The following signs usually indicate a spinal cord injury:

• numbness or tingling in the limbs;
• pain and stiffness in the spine;
• signs of shock;
• inability to move limbs;
• loss of control over urination;
• loss of consciousness;
• unnatural position of the head.

Spinal problems are often the result of accidents or violent acts. The main causes of injury:

• the fall;
• diving in shallow water (the consequences of hitting the head on the bottom of the reservoir);
• trauma after a car accident;
• jumping;
• head injury during a sporting event;
• electrical injury.

First aid for spinal injuries

The consequences of spinal injuries can be quite serious, so it is very important to provide first aid to the victim in a timely and appropriate manner. Any damage to the spinal column is considered complex, dangerous and requires immediate hospitalization in a hospital.

The tactics of providing first aid for spinal injuries depends on the severity and localization, the complexity of the structure of the injury area and the functional significance. The consequences for the body after exposure to an acute injury directly depend on how correctly the first aid will be provided to the person.

Assistance provided after a spinal injury includes the following:

• immediately call an ambulance;
• lay the patient on a flat surface;
• ensure the complete immobility of the victim, even if he thinks that he can move on his own;

Diagnostics

When the victim is taken to the hospital, doctors will perform a physical examination and a complete neurological examination to determine the nature and location of the injury.

Based on the examination data, the patient is assigned imaging methods that allow to determine morphological changes in tissues after injury.

Radiography - allows you to diagnose fractures and dislocation of the vertebrae.

CT- this research method is necessary for better visualization of both bone and soft tissues that are damaged during spinal injury. In addition, CT is a more preferable diagnostic method in the case when the patient's condition is critical and it is necessary to quickly determine the cause of the condition and prescribe emergency therapy.

MRI. This method is useful for detecting signs of spinal cord injury, hemorrhages and other morphological changes in soft tissues.

EMG (ENMG) - allow you to determine the damage to the nerves and the level of damage.

ECG, ultrasound, laboratory methods studies are ordered to exclude other consequences of injuries, especially when it comes to combined injuries as a result of accidents /

Densitometry - required for suspected osteoporosis.

Treatment of spinal injuries

All trauma patients should be provided with spinal protection and immobilization until spinal cord injury has been ruled out or management has been determined.

Basic principles of treatment of spinal injuries:

• All trauma patients should be supported in the supine position, with strict bed rest.
• The patient must be transported using a shield
• Patients with trauma to the cervical spine need to ensure the stabilization of the neck with a rigid cervical collar (corset)
• The patient must be in a wheelchair

Further treatment tactics depend on the clinical and radiological assessment of the injury.

The main goal of treatment is to stabilize the spine and eliminate any compression on the spinal cord.

Since not all patients with spinal injuries are accompanied by spinal cord injury or spinal instability, the final treatment ranges from brace immobilization to surgery. There are indications for each method, and one treatment method cannot be used for all types of injuries.

Treatment methods for spinal injuries

• Non-surgical treatment
• Surgical treatment
• Closed reduction with or without surgery (cervical spine only)

Non-surgical treatment of spinal injuries

Non-surgical treatment remains the standard of care for spinal injuries. Most injuries can be treated with these techniques.

Closed treatment options:

• Traction - for injuries of the cervical spine
• Bed rest with regular periodic torso rotations to avoid bedsores.
• External corset or plaster.

Wearing a corset continues for 8-12 weeks for cervical injuries and 12-24 weeks for thoracolumbar injuries. This is the time required for sufficient consolidation of the fracture to occur so that the bone can withstand the load.

Prolonged bed rest as a definitive treatment may be recommended in rare cases where patients are unwilling to wear a corset or surgery or are not suitable for this treatment due to severe preexisting deformity, morbid obesity or medical problems, etc.

In some patients, late conservative treatment may result in chronic pain.

Surgical treatment of spinal injuries

Surgical stabilization of the spine is aimed at:

• Prevention of further mechanical damage
• Decompression of the spinal cord by removing structures that cause compression, such as bone fragments

• Skeletal instability with neurological deficit.
• Unstable ligament injury in an adult patient with no response to conservative treatment
• Having multiple injuries
• Combined injuries

Spine surgery for trauma differs depending on the level of injury, but have the following general principles:

• Decompression
• Fixation of the damaged segment with an implant
• Fusion of segment with bone graft

The purpose of the implant is to hold the segment in position until fusion occurs. If the fusion is not carried out, then the implant will fail one day and the spine will become unstable again.

There are various instruments for spinal surgery, and each of them has its own advantages and disadvantages.

closed reduction

This method is used for dislocations of the cervical spine. The principle of this method is to use heavy weights for traction so that a slow maneuver can be performed to reduce the spine. This is a completely safe method. Neurological deterioration with reduction is a very rare risk, especially if the reduction is done carefully.

This method requires placement of Crutchfield or Gardner-Wells traction forceps.

Unconscious patients should have an MRI scan prior to reduction.

Reduction is not performed for injuries such as craniocervical dissociation or trauma to the cervical spine with signs of distraction.

Benefits of closed reduction

• Reduces the need for complex surgical procedures
• Improves stability, prevents neurological deterioration, or may improve neurological status
• Reduction in the first few hours of injury can lead to a significant improvement in neurological status.

However, there is no effective method of closed reduction for the thoracolumbar spine yet.

Prevention

Unfortunately, injuries to the spine and spinal cord are unpredictable, but the risk of injury can be greatly reduced by following simple safety precautions.

• The seat belt must always be worn while driving.
• Appropriate protective equipment must be worn when playing sports.
• Do not dive in unfamiliar waters
• Strengthen the muscular system to provide proper support to the spine.
• Do not drink alcohol while driving.

Basically, these are young people (18-30 years old). By the way, this is not only a social problem, but also an economic one, since there is a high risk of disability.

Classification

Shift mechanism characteristic of the thoracic region. In this case, the traumatic force is directed along the frontal plane. This mechanism causes fractures-dislocations, which are often complicated by damage to the spinal cord.

By type of injury

Depending on the injury, spinal injuries are divided into open and closed.

The following types of injuries are distinguished:

• Compression fracture of a vertebra. Such damage is often received by people with the presence of osteoporosis. With a compression fracture, their cervical vertebrae are compressed.
• Distortions and tearing of the ligaments, but without displacement of the vertebrae. The ligamentous fibers that surround the spine are torn or stretched. Such injuries are considered minor.
• Disk damage. The fibrous ring breaks, which leads to prolapse of the nucleus pulposus. This causes the appearance of an intervertebral hernia.
• Fracture of the spinous process. It can be isolated and combined, without displacement and with it.
• Dislocations and subluxations. The injury causes the vertebrae to move, making it difficult to move.
• Spondylolisthesis. The vertebra, which is located above the damaged one, is shifted.

In addition, stable and unstable lesions of the vertebrae are distinguished.

F.Denisa classification

The most convenient classification is F. Denisa, which combines criteria of various types.

The manifestations of injury and the severity of the injury are determined:

• Area of ​​damage.
• mechanism of damage.
• Stability of the injured spinal segment.

The fracture is accompanied by mechanical or neurological instability, depending on the spinal column involved.

With fractures of the spine, the prognosis is made very carefully. It can be positive if the person did not die from pain shock or the spinal cord was not damaged..

Risk Factors for Spinal Injury

And did you know that…

Next fact

These factors are divided into two types.

Fatal:

• Floor. Women are prone to osteoporosis, especially after having a baby. This disease negatively affects the skeletal system of the spine.
• Age. It is not uncommon for men to develop osteoarthritis in adulthood.
• genetic predisposition. The risk is greatly increased if the parents have spinal problems.
• Dysplasia of joints and bones. The presence of congenital diseases.

Disposable:

Risk factors for spinal injury must be completely eliminated. If an injury occurs, then the treatment must be completed.

Video: "Sports spinal injuries"

The most frequent and common causes

Causes of spinal injuries are:

• Injury due to falling on the back: fainting, downhill skiing, while skating.
• Damage sustained while diving into water. Often the victim has a strong bending of the neck, which causes injury with serious consequences.
• Road traffic accidents. Both the pedestrian and the driver are injured. In a collision or emergency braking, a whiplash injury occurs when the neck is first bent and then sharply extended.
• Collapse. Such accidents occur at a construction site, a mine or a hazardous industry.
• Injuries. They can be gunshot, cutting, stabbing. The consequences depend on the degree of penetration and location.
• bruises. These are the most common injuries that are often overlooked. But bruises are so serious that they lead to impaired nerve conduction and motor functions.

A fairly common cause of spinal injury is a fall from a height. One has only to slip and fall on the buttocks. This often causes injury to the coccyx, which is very vulnerable.

In 30% of cases, spinal injuries are accompanied by spinal cord injury., which often manifests itself as a serious complication. Inflammatory processes entail serious consequences for the body (paresis, paralysis).

Conclusion

Taking good care of your health can significantly reduce your risk spine injuries. It is necessary to increase the endurance of the spine and form a strong muscular corset. This is achieved by dosed training and controlling body weight.

In addition, you need to avoid dangerous situations on the road, during training and at home. Naturally, such situations can not always be prevented, but still one should try to prevent them.

Even the slightest contusions should not be regarded as minor injuries, since symptoms can often occur long after the injury. Any injuries should deserve due attention.

Spinal injury is, fortunately, not the largest group among trauma patients, but due to the exceptional significance of structural injuries, the complexity and severity of their consequences, the difficulty of treatment and the high level and degree of disability of the victims, it is of particular importance.

Statistical data on spinal cord injury is heterogeneous. Different authors give different information about the frequency and nature of damage. The proportion of spinal injuries in total traumatism ranges from 1.7 to 17.7% (N.N. Priorov, 1939; V.S. Balakina and K.V. Kvitkevich, 1960; V.M. Ugryumov, 1979; and others .). N.T. Litovchenko, L.M. Bukhman and N.V. Petushenkova (1960) note that among neurotraumatological patients, those who have undergone spinal trauma make up 10.5%. N.I. Mironovich, who studied the summary data of the country's neurosurgical institutions for 5 years, determines this group of patients at 14.5%. According to the observations of Ya.L. Tsivyan (1971), more than half of spinal fractures are accompanied by damage to the spinal cord. AI Geimanovich (1947) points to spinal cord injury in 70% of closed spinal injuries. Most authors (F.R. Bogdanov, 1954; I.E. Kazakevich, 1959; V.D. Golovanov, 1960; Z.V. Bazilevskaya, 1962; and others) believe that the frequency of spinal cord injuries in closed spinal injuries ranges from 23.81 to 34.5% of all cases.

Damage to the cervical segments of the spinal cord is 17-30%, thoracic - 18-30%, lumbosacral - 40%, sacral and cauda equina - 23-27%. Among the patients observed by us, trauma of the cervical localization occurred in 21%, damage to the thoracic region in 31.3%, lumbosacral region in 43.7%, trauma to the cone and cauda equina in 4% of the victims. And according to our data and according to the literature, 5-6 cervical, 11-12 thoracic, 1-2 lumbar vertebrae are most often damaged.

About 20% of spinal cord injuries are multifocal. In 32% of patients, we noted a distant syndrome (functional insufficiency of segments remote from the lesion). In 25% of cases of spinal injury, DG Golberg (1952) did not find any spinal injuries. According to Kh.M. Freidin (1957), a purely spinal injury occurs in 14%. Among our patients, spinal symptoms with an intact spine were observed in 2.3% of patients.

In the vast majority of cases (88.6%), spinal cord injury is closed. In peacetime, open injuries of the spine and spinal cord occur in 4.4% (N.I. Mironovich, 1971). In the military theater their number is increasing. In wartime, the number of combinations of spinal injuries with thoracic, abdominal, cranio-cerebral and other injuries also increases. Under normal conditions, such combinations are observed in 6.9% of spinal injuries.

According to summary statistics, it is generally accepted that, in general, vertebral-spinal injury in peacetime ranges from 1 to 4% of all types of injuries (V.I. Dobrotvorsky, 1929; Z.V. Bazilevskaya, 1962; V.M. Ugryumov, 1979 ; K. G. Nirenburg, 1970; and others). Only a few authors (H.M. Freidin, 1957; K. Arseni, M. Simionescu, 1973) determine the proportion of injuries of the spine and spinal cord in total injuries at 0.33-0.8% and 0.7-1% .

In recent years, in connection with the development of industry, the penetration of mechanization into construction, agriculture, the growth of intensification of production, the development of vehicles, and urbanization, there has been a clear trend towards an increase in the number of injuries to the spine and spinal cord. Many authors note that in recent years the proportion of vertebral-spinal injuries has increased by almost 30 times. According to O. G. Kogan (1967, 1975), annually out of every 10 million inhabitants, 100-150 people suffer damage to the spine and spinal cord. From here it is easy to calculate for each region how many new patients appear every year. In the country as a whole, the number of injured is about 4,000 people. According to Murray M. Freed (1990), in the United States, there are 20 to 50 cases of injuries of the spine and spinal cord per 1 million inhabitants, and from 3.5 to 10 thousand victims are registered annually. The annual increase in this type of injury is 1.7%. R. R. Meyer et al. (1991) report similar data. According to long-term forecasts, a further increase in spinal injuries is expected (A.N. Konovalov et al., 1986).

UDC::(470+571)

Traumatism in the Russian Federation on the basis of statistics data
Andreeva T.M.
N.N.Priorov Central Institute of Traumatology and Orthopedics

Keywords: statistical form, traumatism.

key words: statistical form, traumatism.

Injuries, poisoning and some other consequences of external causes have a negative impact on health indicators, due to their high prevalence among various population groups and high rates of adverse social consequences: temporary and permanent disability, mortality. WHO, having proclaimed the first decade of the XXI century (2000-2010) a decade for the treatment of bones and joints, defines the prevention and treatment of limb injuries as one of the 5 priority problems of musculoskeletal diseases. In the complex of therapeutic and preventive measures aimed at solving this problem, an important place is occupied by the prevention of injuries and the provision of qualified specialized medical care to victims of injuries and other accidents. Form No. 57 “Information on injuries, poisonings and some other consequences of external causes”, approved by the resolution of the State Statistics Committee of Russia in 1999, is aimed at the widespread registration of those who applied for injuries, poisonings, burns and other consequences of external causes for medical care in all medical institutions.

The purpose of this work was to analyze the injury rate presented in the official statistical form No. 57, evaluate it and suggest ways to improve the collection of statistical data.

In 2009, 10,029,342 adult victims sought medical help for injuries, poisonings, and some other consequences of external causes. The injury rate was 86.6 per 1,000 adults. Compared to 2008, the number of injuries registered among the adult population decreased by 1.6%, and the injury rate decreased by 1.9% (Table 1).

Table 1

Dynamics of injuries among the adult population of the Russian Federation

Despite the fact that in 2009, compared to 2008, injury rates decreased in all federal districts, still in the Volga, Siberian, Northwestern, Far Eastern and Ural federal districts, the injury rate exceeds the national average by 10.6, respectively; 9.3; 8.2; 7.9 and 5.7%.

Among the victims of injuries and other accidents, more than half (56.7%) were men, whose injury rate was 108.7‰, and among women - 68.4‰ (Table 2).

table 2

Indicators of injuries, poisonings and some other consequences of external causes among the male and female population of the federal districts

The highest injury rates among the male population, exceeding the Russian average by 1.4-1.6 times, were noted in the Kemerovo region (167.8‰), Perm region (165.6‰), Magadan region (155.3‰) and Irkutsk region (148.8‰). In women, the highest injury rates were registered in St. Petersburg (99.4‰), Perm Territory (99.2‰), Kemerovo Region (93.9‰).

In the structure of injuries among the adult population, as in previous years, both men and women receive the vast majority of injuries and other injuries in everyday life. Household injuries accounted for 69.9% of injuries in the structure. Second place is occupied by street injuries, they account for 19.6%. Work-related injuries, which rank third in the structure of injuries, account for only 4.1% (4.8% for men and 3.1% for women). The fourth place (3.8%) is occupied by other injuries that are not were classified according to the type of injury. Transport and sports injuries, ranked fifth and sixth, account for 1.9% and 1.1%, respectively. The structure of injuries by its types is practically not subject to gender influence (Table 3).

Table 3

The structure of injuries among the adult population of the Russian Federation in 2009 (in %)

In the structure of injuries registered in the federal districts, injuries received at home and on the street also prevailed over all other injuries. The level of domestic injuries ranged from 80.6% (Southern Federal District) to 48.1% (North Caucasian Federal District). Street injuries were subject to significant fluctuations, ranging from 13.4% (Southern Federal District) to 37.8% (North Caucasian Federal District) in the overall structure of injuries. The third place is occupied by occupational injuries with fluctuations from 2.2% (Southern Federal District) to 5.8% (Siberian Federal District). The level of transport injuries was the highest in the North Caucasian Federal District (4.0%). In the North Caucasian Federal District, sports injuries were 3.5 times higher than the national average (Table 4).

Table 4

Structure of injuries among the adult population of federal districts by types of injuries in 2009 (in %)

The structure of injuries associated with production activities is presented in Table 5.

Table 5

The structure of occupational injuries among the adult population of federal districts in 2009 (in %)

On average, the share of injuries in industrial production accounts for 53.4%; in the Southern Federal District, the share of injuries in industry was the highest and amounted to 61.4% of all industrial injuries. More than a third of the victims were not classified according to the type of injury and were classified as others (36.5%). Agricultural injuries account for only 4.2% in the total structure of industrial injuries with significant fluctuations from 1.5% (Central Federal District) to 17.4% (North Caucasian Federal District). In the North Caucasian Federal District, the highest level of transport injuries associated with production activities (17.4%) was also noted, which is 4 times higher than the national average.

The nature of injuries in the general structure of injuries is constant, and practically does not depend on the injury rate (Table 6).

Table 6

The structure of injuries among the adult population of federal districts by the nature of injuries in 2009 (in %)

As already mentioned, the injury rate in men is higher than in women and exceeds the latter by almost 1.5 times. Injuries among the male population are more severe. Crush injuries, traumatic amputations and injuries of internal organs were recorded 3 times more often in men, intracranial injuries with fractures of the skull bones, fracture of the spine almost 2 times more often.

More often among the adult population, bruises, superficial injuries without damage to the skin are recorded, which amount to 26.5‰ or 30.6% (Table 7). The second place in the structure of injuries in terms of seeking medical care by the population is occupied by bone fractures, accounting for 18.6 cases per 1000 of the adult population, or 21.5%.

Table 7

Rates of injury, poisoning and other accidents among the adult population in 2009

Of all the fractures, 86.6% were localized on the extremities, including 38.2% on the upper ones. The third place in the structure of injuries is occupied by open wounds and injuries of blood vessels - 15.9‰, or 18.4% of the total number of all registered injuries. The fourth place among the recorded injuries belongs to dislocations, sprains, injuries of muscles and tendons. The rate of this type of damage was 10.8 per 1000 adults or 12.4%. Intracranial injuries (without fractures of the bones of the skull) are ranked fifth, which account for 3.3‰ or 3.8%, and together with fractures of the skull - 5.1%. The sixth ranking place in the structure of injuries (2.4%) belongs to burns, which were recorded in 2.1 cases per 1000 adults. Other ranking places in the structure of injuries are occupied by injuries of the eye and orbit (1.7%), crushing (crushing), traumatic amputations (0.7%), injuries of internal organs of the chest and abdominal cavity (0.2%), injuries of nerves and spinal cord (0.1%).

In 2009, 3,001,726 victims aged 0 to 17, inclusive, applied for medical assistance for injuries, poisonings, and some other consequences of external causes. The injury rate for children aged 0-17 was 115.2‰ (Table 8).

Table 8

Prevalence of injuries, poisonings and some other consequences of exposure to external causes in children (0-17 years old) in 2009

In 4 federal districts (Central, North-Western, Volga and Far East) injury rates for both boys and girls were higher than the national average.

Table 9

The structure of child injuries by the nature of injuries in 2009 (in %)

Among the injured children, boys prevailed, accounting for 61.8% of all injuries. The injury rate for boys was 139.0‰, for girls – 90.3‰.

Injuries and consequences of other accidents in boys were more severe. They more often received open wounds and injuries of blood vessels, fractures of the bones of the skull, injuries of the eye and orbit, fractures of the bones of the upper and lower extremities (Table 9).

The structure of injuries at the place of injury was characterized, both in boys and girls, by the predominance of household and street injuries (Table 10). Injuries in the walls of the house, in the yard and on the street accounted for over 80% of all injuries sustained by children in the country on average.

Table 10

Structure of child injuries by types of injuries in the Russian Federation in 2009 (%)

The structure of injuries by its types in the federal districts, except for the North Caucasus, is of the same type: injuries received at home and on the street predominate (Table 11).

Table 11

The structure of child injuries by types of injuries in federal districts in 2009 (in %).

These types of injuries account for over 80% of injuries registered in children. In the North Caucasian Federal District, the first place is occupied by street injuries (41.6%). 1.8 times higher than the level of transport injuries and almost 1.5 times higher than sports.

Discussion.

The structure of injuries by its types and nature of injuries in both adults and children retains its picture throughout the entire period of study and does not depend on the injury rate. It should be noted a significant decrease in the share of occupational injuries in the overall structure of injuries among the adult population, which is explained by the socio-economic changes taking place in the country. Significant fluctuations remain in injury rates when comparing indicators of territorial entities. The highest injury rates among the adult population are recorded in the Perm Territory (128.8‰), Kemerovo Region (127.0‰), Magadan Region (120.8‰), and the lowest in the Chechen Republic (31.9‰), Karachay-Cherkess Republic (34.7‰) and the Republic of Kalmykia (44.7‰). Injuries among the child population are also characterized by low rates in these republics (the Chechen Republic - 33.8‰, the Karachay-Cherkess Republic - 38.0‰ and the Republic of Kalmykia - 38.7‰). In Moscow, Primorsky Territory and Kamchatka Region, the highest rates of child injuries are recorded, which are 187.2; 166.7 and 162.7‰, respectively.

It is possible that in the southern regions the injury rate is actually low. To answer this question, it is necessary to compare the level of injuries with the level of hospitalization and mortality rates in these territorial entities. In the work of Leonov S.A. et al. (2009) studied how fully the official statistical annual reporting form No. 57 "Information on injuries, poisonings and some other consequences of external causes" can reflect the problem of road traffic injuries in the country. With a high degree of probability, an underestimation of injuries presented by official statistics has been demonstrated. Another example of injury underreporting on Form 57 is the comparison of data on poisonings recorded on Form 57 with data on inpatient treatment of victims of poisoning. In 2009, 71,723 victims were recorded in adults in form No. 57, and 160,882 victims received inpatient treatment. In children, a similar picture is observed: 17,758 victims in form No. 57 versus 41,085 in form No. 14. As is known, data on injuries, poisonings and other consequences of external causes, presented in form No. 57, reflect only registered morbidity based on the appeal of the population for medical help. The appeal of the population for medical care depends on a number of factors, these include: the availability of outpatient and inpatient care, the socio-economic and cultural level of the population. In addition, the quality of accounting for injuries and other consequences of external causes in outpatient facilities also plays an important role. Thus, when analyzing child injuries, it was revealed that in a number of territories the proportion of injuries classified as “other” is too high: in the Vladimir and Kirov regions it was 13.2%, in the Udmurt Republic - 18.5%.

Proper organization of accounting and reporting creates the necessary conditions for analyzing the causes of injuries and developing effective measures to prevent it. The reliability of accounting for injuries and the necessary amount of information about their nature can only be ensured if the rules for filling out statistical documents are carefully observed.

An analysis of injuries in dynamics over the past 7 years, based on the data presented in form No. 57, revealed “weak points” of the statistical form. First of all, this is an underestimation of injuries. Undoubtedly, it is impossible to achieve a complete account of all damages, but it can be improved. The underreporting of injuries appears to be due to two main causes. First, “light and relatively light” injuries are not recorded, with which the victims do not seek medical help. The solution of this issue is associated with an increase in the availability of medical care and the formation of a caring attitude towards health among the population. Second, a fairly large part of those who suffered from injuries, poisonings and other consequences of external causes are delivered to the hospital by ambulance, bypassing the outpatient department. After discharge from the hospital with recovery, the victims may not go to outpatient clinics, and these injuries are not recorded. The US National Center for Injury Prevention and Control maintains an electronic record of all hospitalized injuries. It would be possible to discuss the question of the possibility of filling in hospitals with statistical coupons for patients discharged with recovery.

The classification of damage in form 57 is compiled in accordance with ICD-10. An analysis of the listed damages allows us to make several remarks. First, in lines 19-20, referring to a fracture of the bones of the lower limb, a fracture of the lower end of the femur is indicated. The selection of this damage in a separate line is not justified. Of greater importance are fractures of the proximal end of the femur (intertrochanteric, pertrochanteric and subtrochanteric hip fractures), which most often occur as a result of falls, especially in the elderly and usually require high-tech methods of treatment. Second, lines 35-36, which reflect the complications of surgical and therapeutic interventions that are not qualified in other headings, do not directly relate to injuries. In ICD-10, headings T80-T88 mean complications associated with infusion, transfusion and therapeutic injection (T80), complications associated with cardiac and vascular (T82), genitourinary (T83), orthopedic (T84), other internal (T85) devices , implants and grafts; with death and rejection of transplanted organs and tissues (T86), with complications characteristic of replantation and amputation (T87) and with others (T88). All the conditions listed above are not directly related to injuries as such, and therefore lines 35-36 can be deleted. If you leave this heading, then all complications should be distributed by type of injury, and not grouped only in columns 9 and 23 (others), since the complications listed above can be with any type of injury. Third, lines 37-38 form information about the consequences of injuries, poisonings and other influences of external causes. The ICD-10 defines these data: the categories listed should be used to designate conditions listed under S00-S99 and T00-T88 as causes of long-term effects that are themselves classified elsewhere. The concept of "sequel" includes these conditions as such or as long-term effects that persist for a year or more after an acute injury. In accordance with the instructions for compiling the reporting form No. 57, it is formed on the basis of information about acute injuries and injuries, therefore, complicated injuries should not be recorded in this form. There are two arguments for the legitimacy of this conclusion. Firstly, the treatment of the victim with an acute injury should already be registered earlier and secondly, if any consequences of injuries are formed (for example, delayed fracture consolidation, formation of a false joint or bone deformity), then these consequences are transferred to another nosological unit.

Considering the current state of society, it would be desirable to add a column to the types of injuries presented in form No. 57, reflecting the injuries caused by another person with the aim of injuring (beatings, fights, etc.). This column will group injuries as a result of violent acts, regardless of the place of their occurrence,

The classification of industrial injuries was proposed by S.Ya. Freidlin in 1963, has now become uninformative. The rate of occupational injuries over the past 10 years has decreased by 4 times and became equal to 3.5‰, which is only 4.1% in the total structure of injuries among the adult population. In the production injuries themselves, 53.4% ​​are injuries received in industry, and 36.5% of injuries are classified as other, 5.9% are transport injuries, and 4.2% of injuries are received in agriculture. For any classification, such a value for "other" is invalid.

Any grouping of data is determined by the purpose and objectives of the study. Correct grouping allows you to identify factors that affect the nature and distribution of injuries, establish the degree of influence and the relationship of factors, and study quantitative changes in homogeneous groups. It cannot be regarded as something frozen, since injuries, poisonings and other accidents are extremely sensitive to socio-economic changes. The cardinal changes that have taken place in society over the past decade have made their own adjustments, both in the structure of injuries and in the nature of its injuries, therefore, for a more complete characterization of injuries, its grouping should be revised.

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