Sequential external osteosynthesis of gunshot fractures of limb bones at the stages of medical evacuation

Staged treatment of the patients with gunshot fractures of long bones implies a differentiated approach to the choice of different methods and means of extremity immobilization taking into account their peculiarities and functional capabilities. The frequency of different types of osteosynthesis in specialized care of 212 wounded patients with 276 gunshot fractures of long bones who were immobilized with external fixation devices (EFD) at the stage of advanced care was analyzed. It was revealed that when performing sequential osteosynthesis, preference for internal constructions was given — 122 (44.2%) observations. External osteosynthesis with Ilizarov apparatus (IA) was second most frequently used — 87 (31.5%). EFD was used as the definitive method of treatment in 67 (24.3%) cases. We studied and compared the constructive and functional capabilities of EFD and IA. The main advantage of the Ilizarov apparatus is the ability to control the position of the fragments and influence the process of regeneration by creating compression and distraction forces. The advantage of the EFD is the simplicity of use and, accordingly, the possibility of rapid fixation of the limb in resource-poor conditions with the simultaneous admission of a considerable number of wounded patients. Application of IA implies complex reconstructive interventions with prolonged subsequent treatment and rehabilitation. It should be taken into account when organizing staged treatment and use the type of osteosynthesis that corresponds to a particular stage. When providing qualified care, the use of EFD is absolutely indicated; when performing complex reconstructive operations of specialized trauma care, it is advisable to use the capabilities of the Ilizarov method.