The review deals with modern methods of assessing the severity and predicting the outcome of polytrauma. To solve the problem of objective evaluation of polytrauma severity, numerous studies are devoted to the search for independent predictors of its outcome, many of which are included in various scales and statistical models to quantitatively rank the severity of injury in the established intervals and calculate the survival probability. It is generally accepted to take into account the anatomical criteria to determine the severity of damage, and physiological parameters that characterize the response of the body functional systems to the damage. Age, sex, comorbidities, various clinical parameters, indices of acidosis, coagulopathy, oxidative stress, inflammatory response, timely diagnosing and the quality of treatment, the need of rendering various types of emergency aid are considered as independent risk factors of fatal polytrauma outcome.The predictive value and comparative effectiveness used in polytrauma scales assessing the severity of injuries (ISS, NISS, APS, ICISS, TMPM) and functional disorders (GCS, RTS, APACHE II, MODS II, SOFA, SAPS II, MPM II) as well as a variety of combined clinical and anatomical evaluation systems (TRISS, ASCOT, RISC II, PTS, etc.) are being actively discussed in the modern literature. Creating a universal scale is complicated by a variety of damages and disorders caused by a polytrauma, and insufficient study of injury outcome predictors. The proposed survival rates and prognostic factors are tied to specific polytrauma databases differing in terms of mortality and quality of medical care, which is reflected in their predictive value.A clear definition of polytrauma and formation of a unified system of assessing its severity would allow physicians to standardize treatment policy, objectively solve the problems of organization and financial support of medical help to seriously injured people.Key words: polytrauma; prognostic factors in polytrauma; mortality in polytrauma; scales and systems of injury severity evaluation.For contacts: Pavel A. Seliverstov,

Заболевания гепатопанкреатобилиарной системы представляют собой актуальную клиническую проблему, поскольку встречаемость их неуклонно растёт. Проведён литературный обзор лучевых методов в диагностике окклюзионных поражений желчевыводящих путей. При использовании инструментальных методов исследования отмечены их диагностические возможности. Открытой темой остаётся оптимизация диагностического алгоритма состояния органов гепатобилиарной зоны в целях уточнения характера причин механической желтухи.

The review describes peculiarities of the choice of time and methods of osteosynthesis offemur fractures of different localization in patients with multiple injuries in accordance with modern concepts of treatment of severe multiple and associated lesions. Analysis of domestic and foreign literature shows that earlyfixation of the femur in case of polytrauma can reduce the mortality rate associated with complications and improve the functional outcome. Terms of osteosynthesis of the femur in polytrauma should be chosen taking into account the severity of the injury, the patient's condition, and the period of traumatic disease. The procedure of osteosynthesis must not be a threat to the clinical condition. The choice of the method for fixation of the femur depends of fracture type and location, the presence of fractures in the adjacent and remote segments. The minimally invasive techniques of osteosynthesis of the femur and staged surgical treatment of the victims in an unstable state should be chosen for the treatment of multiple injury in accordance with the concept of «Damage Control Orthopedics».

In case of poly-trauma the early operations of osteosynthesis under fractures of long bones, unstable fractures of pelvis and backbone bones being an operational trauma, can provoke progression of inflammatory reaction, development of systemic complications and poly-organ inadequacy i.e. causing a «second hit» effect. The pathophysiologic mechanisms of «second hit» phenomenon are complicated and they are implementing by means of modulation of immune response. The risk of development of the given phenomenon depends on period of implementation and method of osteosynthesis, severity of injuries and condition, age, concomitant pathology of patient, presence of chest trauma and craniocerebral trauma. The study of pathophysiology of «second hit» phenomenon is perspective for development and optimization of clinical concepts of treatment of patients with poly-trauma and skeletal damages.