DESTRUCTION OF BONE AND SURROUNDING TISSUES IN CASE OF GUNSHOT FRACTURES OF LONG BONES OF THE EXTREMITIES (CLINICAL AND RADIOLOGICAL CLASSIFICATION). FIRST REPORT

Abstract

Objective. To determine the nature of the destruction of the bone and surrounding tissues in gunshot fractures of the long bones of the extremities and to create their clinical and radiological classification. Material and methods. 123 cases with gunshot fractures of the long bones of the extremities (127 fractures) were studied. The number of intermediate fragments, the magnitude of their transverse displacement, the length of the bone destruction zone, the shape and size of the soft tissue wound were studied. During the operation, the state of the anatomical connection of the fragments with the periosteum and muscles was assessed. Based on known data on the mass and speed of traumatic agents, calculations of their energy that occur during the action of a bullet and a hit by a moving car were made. Results. 97 % of the victims had multifragment fractures, among them 50 % had 2–3 intermediate fragments, 30 % — 4–6 and 22 % — 7 or more, or a primary bone defect was formed. Based on the number of formed intermediate fragments, the magnitude of their transverse displacement and the presence (or absence) of anatomical connection with living tissues, we distinguished three types of gunshot fracture: 1 — with slight or moderate transverse displacement of the intermediate and main fragments (within the diameter of the bone and with preservation of the longitudinal orientation); 2 — with significant transverse displacement of one or more intermediate fragments (in the direction of the projectile movement) with loss of anatomical connection with the periosteum and formation of a parietal defect of the bone and a wound of medium or large size; 3 — with excessive transverse displacement of all intermediate fragments (in the direction of the projectile movement) with loss of their anatomical connection with the periosteum and formation of a complete transverse defect of the bone. It was found that in the majority (66%) of gunshot fractures, despite the presence of a soft tissue wound, the intermediate and main fragments retain an anatomical connection with the periosteum and muscles, and this is of great importance in choosing treatment tactics.