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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