PROBLEMATIC ISSUES OF THE TREATMENT OF DIAPHYSEAL GUNSHOT FRACTURES OF LONG BONES OF EXTREMITIES
DOI:
https://doi.org/10.15674/0030-598720234109-120Keywords:
Gunshot fractures of the diaphysis, classification, methods of fixation of fragments, results of treatmentAbstract
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.
References
- Lytvyshko, V. O. (2018). Patterns of formation of bone regenerate in the leg of a diaphyseal fracture under the conditions of functional treatment using an elastic-resistant connection of fragments: dissertation of Doctor in Medical Sciences. Kharkiv. (in Ukrainian)
- Popsuyshapka, O. K., Lytvyshko, V. O., & Ashukina, N. O. (2015). Clinical and morphological stages of the fusion of fragments after a bone fracture. Orthopedics, traumatology and prosthetics, 1 (598), 12–20. https://doi.org/10.15674/0030-59872015112-20. (in Ukrainian)
- Vyrva, O. E., Mikhanovskiy, D. O., Bets, I. G., Bitsadze, M. Z., Shevchenko, I. V., Rykun, M. D., & Skidanov, M. A. (2022). Treatment of explosive wounds of the extremities using negative pressure. Orthopedics, traumatology and prosthetics, 3–4, 45–12. https://doi.org/10.15674/0030-598720223. (in Ukrainian)
- Popsuyshapka, O. K., Lytvyshko, V. O., & Borovyk, I. M. (2014). Functional treatment of diaphyseal fractures of limbs using rod devices for elastically stable connection of fragments (methodological recommendations). Kyiv: Ministry of Health of Ukraine, Ukrainian Center for Scientific Information and Patent and Licensing Work. (in Ukrainian)
- Matsumura, T., Takahashi, T., Miyamoto, O., Saito, T., Kimura, A., & Takeshita, K. (2019). Clinical outcome of conversion from external fixation to definitive internal fixation for open fracture of the lower limb. Journal of Orthopaedic Science, 24(5), 888–893. https://doi.org/10.1016/j.jos.2019.01.009
- Buryanov, O. A., Yarmolyuk, Yu. O., Derkach, S. O., Hrytsai, M. P., Klapchuk, Yu. V., Los, D. V., Omelchenko, T. M., & Kolov, G. B. (2023). Criteria for predicting risks in the case of replacing an external fixator with an internal fixator during the treatment of gunshot fractures of the limbs. Orthopedics, traumatology and prosthetics, 1, 5–9. https://doi.org/10.15674/0030-5987202315-9. (in Ukrainian)
- Grigoriev, V. V., Popsuyshapka, O. K., Ashukina, N. O., & Galkin, F. M. (2017). Localization of vascular endothelial growth factor and transforming growth factor-β in the tissues of the perifracture zone after fractures of the long bones of the limbs in humans. Orthopedics, traumatology and prosthetics, 2 (697), 62–69. https://doi.org/10.15674/0030-59872017262-69. (in Ukrainian)
- Popsuishapka, O. K., Ashukina, N. O., Litvishko, V. O., Grigorjev, V. V., Pidgaiska, O. O., & Popsuishapka, К. О. (2018). Fibrin-blood clot as an initial stage of formation of bone regeneration after a bone fracture. Regulatory Mechanisms in Biosystems, 9(3), 322–328. https://doi.org/10.15421/021847
- Lytvyshko, V. O., Popsuyshapka, O. K., & Yaresko, O. V. (2016). Stress-deformed state of fibrin-blood clot and ossification in the area of a diaphyseal fracture under different conditions of connecting fragments and its influence on the structural organization of the regenerate. Orthopedics, traumatology and prosthetics, 1 (602), 62–71. https://doi.org/10.15674/0030-59872016162-71. (in Ukrainian)
- Popsuishapka, A., Litvishko, V., Ashukina, N., Grigoryev, V., & Pidgaiska, O. (2018). Differentiation mechanisms of regeneration blastema cells during bone fracture healing. Orthopedics, traumatology and prosthetics, 2(611), 78–86. https://doi.org/10.15674/0030-59872018278-86
- Popsuyshapka, O. K., Lytvyshko, V. O., Pidgayska, O. O., Ashukina, N. O., Nesvit, K. V., & Maltseva, V. E. (2020). Mechanical and structural features of nonunion of fragments tibia and their significance for treatment. Orthopedics, traumatology and prosthetics, 4, 33–42. https://doi.org/10.15674/0030-598720204. (in Ukrainian)
- Klapchuk, Yu.V., Popsuyshapka, O. K., & Lytvyshko, V. O. (2023). Mechanical and clinical characteristics of the "rod–bone" connection in the case of treatment of gunshot fractures with external rod devices of different manufacturers. Orthopedics, traumatology and prosthetics, 1, 10–17. https://doi.org/10.15674/0030-59872023110-17. (in Ukrainian)
- Popsuyshapka, O. K., Lytvyshko, V. O., Uzhegova, O. E., & Pidgayska, O. O. (2020). The frequency of complications in the treatment of diaphyseal fractures of the extremities according to the data of the Kharkiv traumatological MSEK. Orthopedics, traumatology and prosthetics, 1, 20–25. https://doi.org/10.15674/0030-59872020120-25. (in Ukrainian)
Downloads
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
The authors retain the right of authorship of their manuscript and pass the journal the right of the first publication of this article, which automatically become available from the date of publication under the terms of Creative Commons Attribution License, which allows others to freely distribute the published manuscript with mandatory linking to authors of the original research and the first publication of this one in this journal.
Authors have the right to enter into a separate supplemental agreement on the additional non-exclusive distribution of manuscript in the form in which it was published by the journal (i.e. to put work in electronic storage of an institution or publish as a part of the book) while maintaining the reference to the first publication of the manuscript in this journal.
The editorial policy of the journal allows authors and encourages manuscript accommodation online (i.e. in storage of an institution or on the personal websites) as before submission of the manuscript to the editorial office, and during its editorial processing because it contributes to productive scientific discussion and positively affects the efficiency and dynamics of the published manuscript citation (see The Effect of Open Access).
