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\title{Metabolic Syndrome in the Affected Structure with Limbs Fractures}
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\begin{document}

             \author[1]{Karimov  M.Y.}

             \author[2]{Yakubdjanov  R.R.}

             \author[3]{Kayumov  U.K.}

             \author[4]{Ibadova  M.U.}

             \author[5]{Kabilov  N.R.}

             \affil[1]{  Tashkent Medical Academy}

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\date{\small \em Received: 10 December 2018 Accepted: 3 January 2019 Published: 15 January 2019}

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\begin{abstract}
        


The paper studied metabolic syndrome in the structure of victims with broken limbs. Analyzed the results of examination and surgical treatment of 202 patients with fractures of the limbs on the background of metabolic syndrome. Developed a multidisciplinary approach involving cardiologist, endocrinologist, anaesthetist and expert in resuscitation for planning surgical intervention can reduce intra and postoperative complications.

\end{abstract}


\keywords{metabolic syndrome; limb fractures; intramedullary osteosynthesis blocking; central venous pressure.}

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\let\tabcellsep& 	 	 		 
\section[{Introduction}]{Introduction}\par
etabolic syndrome (MS) is a complex of interrelated disorders of carbohydrate and fat metabolism, as well as mechanisms of regulation of blood pressure (BP) and endothelial function, the development of which is insulin resistance \hyperref[b0]{[1,}\hyperref[b1]{2,}\hyperref[b2]{3,}\hyperref[b3]{4,}\hyperref[b4]{5,}\hyperref[b5]{6]}.\par
The prevalence of metabolic syndrome (MS) in the adult population reaches 25.8\% and increases significantly with age \hyperref[b6]{[7]}.\par
The available literature has not sufficiently studied the structure of victims with limb fractures, the effect of surgery on the results of treatment, against the background of the metabolic syndrome. Not developed a systemic approach, taking into account hypertension, diabetes mellitus, before and after surgical treatment. Taking into account the gerontological age of all injured patients, the goal was set -to study the structure of the victims of long bone fractures, against the background of the metabolic syndrome. 
\section[{II.}]{II.} 
\section[{Material and Methods}]{Material and Methods}\par
The results of the treatment of 202 patients with fractures of the limb, on the background of the metabolic syndrome, in the period from 2015 to 2017 have been studied. Men 78 people (39\%), women 124 people (61). The average age of patients was 69 years. Of these, 21 closed fracture of the humerus, closed fracture of the femoral neck, 91 cases, closed fracture of the femur diaphysis, 31 cases, closed fracture of the bones of the tibia, 59 cases. With the onset of a fracture in patients, an exacerbation of chronic pathology was observed: the cardiovascular system, hypertensive crisis, acute coronary syndrome, hypercoagulative syndrome. Increased blood sugar, hypovolemic shock, violation of a number of biochemical parameters of blood, etc. All these pathological conditions exacerbate the course of traumatic disease. Prior to the operating period, joint adjustments were required, by a cardiologist, an endocrinologist, an anesthesiologist, and a resuscitator. All patients were investigated according to the developed algorithm -a multidisciplinary approach. The examination included: complete blood count, formula, coagulogram, blood biochemistry, blood sugar dynamics, ECG, EchoCS, duplex examination of the vessels of the lower limb over time. 30.7\% (62) of patients with a deterioration of somatic status, absolute contraindications of anesthesia, it was decided to transfer to conservative treatment. A study on comorbidity revealed that all patients have two or more pathologies. Two different pathologies (86 people, 42.5\%). The combination of the three pathologies was observed in 79 people (39.2\%). In 37 patients, four or more pathologies were observed (18.3\%). Examination of hemocoagulation status revealed that almost all patients showed an increased risk of thromboembolic complications, coagulation beginning 2.2 end 3.1; the amount of fibrinogen reached 550±0.6 g/l. and higher. This and other indicators of the blood coagulation system indicated a high risk of thromboembolic complications. Indicators of central venous pressure (CVP) in the examined patients showed an average of 60-40 (normal 80-120) mm water column. CVP of patients was characterized by a decrease in the volume of circulating blood -hypovolemia, decrease in cardiac output, hypoxia of a predominantly circulatory type. All this ultimately led to an increase in hypovolemic shock. Given the age, injury, difficult compensation of hypovolemic shock, is an aggravating factor for the victim. At the same time, CVP is an important diagnostic information in predicting the general condition of the victim. The level of central venous pressure (CVP), that is, the pressure in the right atrium, has a significant effect on the amount of venous return of blood to the heart. With a decrease in pressure in the right atrium from 0 to -4 mm Hg. the inflow of venous blood increases by 20-30\%, but when the pressure in it becomes lower than ?4 mmHg, a further decrease in pressure does not cause an increase in the inflow of venous blood. This lack of influence of a strong negative pressure in the right atrium on the amount of venous blood flow is explained by the fact that in the case when the blood pressure in the veins becomes sharply negative, there is a collapse of the veins flowing into the chest. If the decrease in CVP increases the flow of venous blood to the heart through the hollow veins, then its increase by 1 mm Hg. reduces venous return by 14\%. Consequently, the increase in pressure in the right atrium to 7 mm Hg. should reduce the flow of venous blood to the heart to zero, which would lead to catastrophic hemodynamic disturbances.\par
IV. 
\section[{Findings}]{Findings}\par
Thus, it was determined that patients with fractures of long bones, against the background of the metabolic syndrome, belong to the somatically severe category of patients. The findings indicate that a differentiated approach reduces intra and postoperative complications. A multidisciplinary approach involving a cardiologist, an endocrinologist, an anesthesiologist, and a resuscitator is required to plan an intervention.\begin{figure}[htbp]
\noindent\textbf{1} \par 
\begin{longtable}{P{0.2700187969924812\textwidth}P{0.09266917293233082\textwidth}P{0.1805451127819549\textwidth}P{0.022368421052631576\textwidth}P{0.2716165413533835\textwidth}P{0.012781954887218044\textwidth}}
\tabcellsep \tabcellsep \multicolumn{2}{l}{Closedhumerusfracture}\tabcellsep \tabcellsep 21\\
\tabcellsep \tabcellsep \multicolumn{2}{l}{Closedfemoralneckfracture}\tabcellsep \tabcellsep 91\\
\tabcellsep \tabcellsep \multicolumn{3}{l}{Closed fracture of the femur diaphysis}\tabcellsep 31\\
\tabcellsep \tabcellsep \multicolumn{2}{l}{Closedshinbonesfracture}\tabcellsep \tabcellsep 59\\
\tabcellsep \multicolumn{3}{l}{140 (69.3\%) patients underwent the following}\tabcellsep \multicolumn{2}{l}{spokes 31 cases. Closed leg diaphysis IOSB 9 cases,}\\
surgical\tabcellsep intervention:\tabcellsep closed\tabcellsep Intramedullary\tabcellsep \multicolumn{2}{l}{osteosynthesis with screws for 46 cases, closedIOSB}\\
\multicolumn{4}{l}{osteosynthesis blocking (IOSB) of the femoral diaphysis}\tabcellsep \multicolumn{2}{l}{shoulder 3, closed shoulder osteosynthesis with needles}\\
\multicolumn{4}{l}{11, open osteosynthesis of the proximal femur 10 cases,}\tabcellsep for 30 cases.\\
\multicolumn{4}{l}{closed osteosynthesis of the femoral neck using the}\tabcellsep \end{longtable} \par
 
\caption{\label{tab_0}Table 1 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{2} \par 
\begin{longtable}{P{0.23225352112676056\textwidth}P{0.5890140845070422\textwidth}P{0.028732394366197178\textwidth}}
\tabcellsep ClosedIOSBdiaphysiship\tabcellsep 11\\
\tabcellsep Open osteosynthesis of the proximal femur\tabcellsep 10\\
\tabcellsep Closed osteosynthesis of the femoral neck with needles\tabcellsep 31\\
\tabcellsep ClosedIOSBlegdiaphysis\tabcellsep 9\\
\tabcellsep Osteosynthesiswithscrews\tabcellsep 46\\
\tabcellsep ClosedIOSBshoulder\tabcellsep 3\\
\tabcellsep Closed shoulder osteosynthesis with needles\tabcellsep 30\\
III.\tabcellsep Results and Discussion\\
\multicolumn{2}{l}{143 (70\%) cases were observed leading in}\\
\multicolumn{2}{l}{frequency of metabolic syndrome: Of the 202 patients}\end{longtable} \par
 
\caption{\label{tab_1}Table 2 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{3} \par 
\begin{longtable}{P{0.6607421875\textwidth}P{0.18925781249999998\textwidth}}
Coronary artery disease and hypertension\tabcellsep 143 (70\%)\\
Diabetes mellitus\tabcellsep 46 (23\%)\\
Impairedglucosetolerance\tabcellsep 56 (28\%)\\
Obesity\tabcellsep 112(56\%)\\
Gallstonedisease\tabcellsep 89 (44\%)\\
Chronic pyelonephritis and urinary tract\tabcellsep 96 (47,5\%)\\
infections\tabcellsep \\
\multicolumn{2}{l}{More often they were observed in combination.}\end{longtable} \par
 
\caption{\label{tab_2}Table 3 :}\end{figure}
 		 		\backmatter  			  				\begin{bibitemlist}{1}
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\bibitem[Ametov]{b3}\label{b3} 	 		\textit{Obesity is an epidemic of the XXI century // Therapeutic archive},  		 			A S Ametov 		.  		p. .  	 
\bibitem[Type 2 diabetes. // underreview of acad. RAMS I.I. Dedova. -M Obesity ()]{b1}\label{b1} 	 		‘Type 2 diabetes. // underreview of acad. RAMS I.I. Dedova. -M’.  	 	 		\textit{Obesity}  		2000. p. 111.  	 	 (Metabolic syndrome) 
\end{bibitemlist}
 			 		 	 
\end{document}
