Restorative treatment of victims with multiple gunshot fractures of long bones




multiple gunshot fractures of long bones, system of re¬storative fracture treatment, replacement of fixation method, individual program of medical rehabilitation


Due to the large number of victims of the armed conflict in the east of Ukraine with multiple long-bones gunshot frac­tures, there was a need for comprehensive and step-by-step re­storative treatment at all levels of medical evacuation, espe­cially at III and IV.

Objective: to develop a step-by-step sys­tem for the rehabilitation of victims with multiple long-bone fractures and to prove its effectiveness in preventing the most common complications.

Methods: 380 patients were divided into three groups: the developed system and individual pro­grams of medical rehabilitation were used in the main (119 peo­ple), in I (118) — modern conventional methods of treatment, in II (143 wounded in Afghanistan) — methods, used in the 80th of the twentieth century, with effective rehabilitation. To as­sess the results of treatment, the Luboszyce-Mattisa-Schwarz­berg scale was chosen in the modification of Shevtsov.

Results: a rehabilitative treatment system was developed, including a reasoned replacement of the fixation method (biochemical and clinical blood tests, evaluation of the limb state), an al­gorithm for surgical treatment using modern medical tech­niques (VAC- therapy, ultrasound cavitation, Vivostat® PRF) and IDEP. The best long-term results (1.2–1.5 years) were ob­tained in patients of the main group compared with I and II. The risk of contamination of the operating wound in the patients of the main group decreased by 5.8 %, the occurrence of osteo­myelitis by 4.2 %, the incidence of neurologic deficits by 2.4 %, vascular disorders by 7.3 %, the development of false joints by 2.8 %, contractures — by 11.3 %.

Conclusions: the proposed system of restorative treatment of multiple long-bone fractures is effective in preventing the most common complications.


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