Patient records (2004) - English
COMMITTEE FOR PUBLIC HEALTH
City of MOSCOW
POLICLINIC No.182
Moscow, 7th
Parkovaya Street, No. 8/61
Name: Olga A.
Sorokina
Date of Birth: July
27,
1973
Residence: Russia,
Moscow, 2nd Parkovaya St., No.11,
Appt.24
Status: Disabled, 1st
degree
Extracts
from Medical Records
Olga A. Sorokina, born in
1973, sustained multiple heavy injuries in October 1999 as a
result of a hit-and-run accident: craniocerebral trauma with
diffuse brain contusion, damage of the internal organs (spleen and
bladder rupture) and multiple skeletal traumas (rupture of the
pubic joint, fractures of pelvic bones, open fracture of the lower
third of left femur with dislocation, intraarticular fracture of
left shin, rupture of ligaments in both knees, fracture of right
humer with dislocation) and traumatic, hemorrhagic shock of the 3rd
degree.
In the Intensive Care
Department of State Clinical Hospital No.36, where the patient was
brought by an ambulance, the following operative measures were
performed: spleen excision, closure of urinary bladder, drainage
in the pelvis minor area, diagnostic frezotomy on both sides of
the cranium and fixation of the pelvic bones with a stud fixture.
For 8 weeks the patient was on artificial pulmonary ventilation.
She suffered pneumonia and pneumothorax. Taking into account the
gravity of the patient’s condition, acute spasms of upper and
lower extremities with formation of contractures (deformities) of
distal parts, i.e. hands and feet, doctors decided against
ostheosynthesis and regeneration of knee ligaments and
conservative treatment was chosen. This lead to a consolidation of
the fractures in the wrong positions. After 4 months in the
hospital, the patient was released to ambulatory treatment in the
condition of akinetic mutism. For 8 months the patient was
basically immobile, did not talk and was nurtured by enteral tube
feeding. With daily massage, exercises, drug usage and the help of
specialists from the Institute for Neurosurgery “Burdenko”, speech
therapists from the Center for Speech Pathology and
psychotherapist, by the end of the 1st year, the
patient came to consciousness, started talking and developed
active movements first in her arms, then in her legs.
In 2001 the patient was
submitted to an ambulatory treatment course in the Department of
Neurorehabilitation in the Institute for Neurosurgery “Burdenko”.
During this course the condition of her brain was fully examined,
she had consultations with neurologists, and verticalization was
performed.
After some positive
neurological stabilization, surgical rehabilitation of
skeletomuscular apparatus was started in the State Clinical
Hospital “S. P. Botkin” and in the Central Institute for
Traumatology and Orthopedics “N. N. Priorov”. In 2001, 3 surgeries
were performed: February 12, 2001, Lengthening of Achilles tendon
on the left foot (performed in the 28th Hospital Unit,
State Clinical Hospital “S. P. Botkin”, by doctor M. Yu. Blokov);
July 05, 2001 and October 10, 2001, two surgeries of ossificates
removal were performed on right hip joint and left elbow joint
(Central Institute for Traumatology and Orthopedics “N. N.
Priorov”, 3rd Hospital Unit, doctor Prof. V. G.
Golubev). In January 2002, because of osteoporosis that developed
due to extensive antibiotics usage, a pathological fracture of the
left femoral neck occurred. On February 12, 2002, a total
endoprosthesis of the left hip joint was performed (Central
Institute for Traumatology and Orthopedics “N. N. Priorov”. On
September 16, 2003 the 5th surgery was performed:
removal of left wrist joint contracture (Central Institute for
Traumatology and Orthopedics “N. N. Priorov”). On July 01, 2004
the 6th surgery was performed lengthening the Achilles
tendon on the right foot.
In 2002 and 2003, the
patient underwent courses of medical rehabilitation in the Center
for Rehabilitation at the Central Military Sanatorium in the town
of Saki (Crimea, Ukraine).
Due to the surgical
treatment and rehabilitation in the Sanatorium (pelotherapy,
mineral baths, exercises, massage, physiotherapy) and treatment at
home, the patient achieved significant improvements in her
condition, joint pains diminished, movement amplitudes increased.
The patient is capable of doing certain exercises in bed alone.
With assistance from another person, she can move into the
wheelchair and can walk up to 200 meters, using walkers on wheels
with armpit supports, or using a support table and special devices
on her knees.
According to the
specialists and psychologist at the Institute for Neurosurgery
“Burdenko”, very good progress in rehabilitation of the brain and
intellect was achieved: the consciousness is adequately clear, the
patient gives correct answers to the questions asked to her, reads
a lot, watches television, uses a computer, is very active in her
interests and is highly motivated toward further rehabilitation.
However, there is a certain instability in the psycho-emotional
sphere. The patient is psychologically labile (acarism).
In spite of all the
positive changes, the patient stays in a wheelchair due to the
instability of her knees, the extension contracture in her right
knee and the hyposthenia of her right foot. The patient has an
absolute shortening of the left leg by 3 centimeters, flexion
contracture in interphalangeal joints of III-V fingers on the left
hand, combined contracture of left elbow joint. The patient is
vertically unstable. Rg-gramms show osteoarthrosis of the knee and
talocrural joints, multiple osteoficates in the elbow and knee
joints and moderate osteoporosis of the large extremity joints.
The patient cannot be independent
and self-sufficient.
At this time, the patient is in
after-surgery condition with plaster-cast immobilization of the
right leg.
Further
neuro-orthopedical rehabilitation (pelotherapy, mineral baths,
exercises, massage, physiotherapy, solar baths) is strongly
recommended under sanatorium conditions (Saki, Crimea).
Chief of 1st
Policlinical Department,
Policlinics No. 182
(signature) Dr. T.A.
Chagulava
August 25, 2004.
Official Stamp of Dr. T.A.
Chagulava
Official Stamp of
Policlinics No. 182