PROBLEMATIC ISSUES OF THE TREATMENT OF DIAPHYSEAL GUNSHOT FRACTURES OF LONG BONES OF EXTREMITIES

M. Korzh, O. Popsuishapka, V. Lytvyshko, Igor Shevchenko, Y. Doluda, Stanislav Gubskyi, Anastasiia Hrytsenko, Dmytro Mikhanovskiy, Olexii Marushchak, Mykola Tokhtamyshev, Zorik Arutunan
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Abstract

Due to the military conflict in Ukraine, the problem of treating gunshot fractures has become acute, which requires an urgent solution. Objective. On the basis of own experience, to determine the primary problems in the treatment of gunshot diaphyseal fractures of the long bones of the limbs and evaluate the preliminary results. Methods. The treatment process and its results were analyzed in 128 victims with gunshot fractures of long limb bones for the period 08.2022–08.2023. Classical methods of clinical, X-ray and laboratory investigations were used. The assessment was carried out according to the AO classification, that was supplemented with new options for tangent and perforated bone injuries, as well as the volume of destruction of adjacent soft tissues. Wounds of all the patinets were treated using vacuum aspiration, the fragments were fixed with external devices manufactured by Biomet, Stryker, ТОВ «Ейч Ві Орто», ОРТОПАК. Results. The analysis showed that 64 (50 %) of the wounded had a need to take additional measures to preserve or improve the position of the fragments: improvement of the geometry of the external apparatus, replacement of the apparatus with a more perfected one, with a plate or intramedular osteosynthesis; replacement of the apparatus with a plaster bandage or orthosis. Conclusions. Based on the study, it can be argued, that most gunshot diaphyseal fractures of long bones are multifragmental and accompanied with destruction of predominantly peripherally located soft tissues. At the same time, the periosteum with a layer of adjacent muscles for the most part retains integrity, viability and connection with the surface of the fragments. The basic and rational method of fixation of fragments for diaphysical gunshot fractures it is necessary to consider external osteosynthesis with schanz-screws devices. According to our preliminary data, the use of external fixator treatment led to fracture healing in 84% of patients with gunshot hip fracture, 56 % — tibia fracture, 59 % — humerus fracture, and 44 % — forearm fractures.
四肢长骨骨骺枪击骨折治疗中的疑难问题
由于乌克兰的军事冲突,治疗枪伤骨折的问题变得十分严峻,亟待解决。目的。根据自身经验,确定治疗四肢长骨枪击性骨骺骨折的主要问题,并对初步结果进行评估。方法。对 2022 年 8 月至 2023 年 8 月期间 128 名四肢长骨枪击骨折患者的治疗过程及其结果进行分析。采用了传统的临床、X 光和实验室检查方法。评估根据 AO 分类法进行,并补充了切线和穿孔骨伤以及邻近软组织破坏量的新选项。所有患者的伤口均采用真空抽吸法进行处理,并用Biomet、Stryker、ТОВ "Ейч Ві Орто"、ОРТОПАК等公司生产的外部装置固定碎片。结果显示分析表明,64名(50%)伤者需要采取额外措施来保护或改善碎片的位置:改善外部装置的几何形状,用更完善的装置、钢板或椎体内骨合成装置替代装置;用石膏绷带或矫形器替代装置。结论。根据这项研究,可以认为大多数枪弹造成的长骨骺端骨折都是多段骨折,并伴有主要位于外周的软组织破坏。与此同时,骨膜和邻近的肌肉层在大多数情况下保持了完整性、活力以及与骨折片表面的连接。因此,有必要考虑使用 schanz-screws 装置进行外固定。根据我们的初步数据,使用外固定器治疗后,84% 的髋部枪伤骨折患者骨折愈合,56% 的胫骨骨折患者骨折愈合,59% 的肱骨骨折患者骨折愈合,44% 的前臂骨折患者骨折愈合。
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