[Clinical experience with various techniques integrated treat the wounded with gunshot fractures of limbs]. / Klinicheskii opyt primeneniya razlichnykh metodik kompleksnogo lecheniya ranenykh s ognestrel'nymi perelomami kostei konechnostei.

AIM: To increase an efficiency of complex treatment of patients with diaphyseal gunshot fractures of long bones by introduction of modern minimally invasive surgical techniques of internal osteosynthesis into clinical practice of civil health care and to improve the outcomes in victims. MATERIAL AND METHODS: Prospective comparative clinical trial included 104 victims from the Republic of Yemen with gunshot wounds of limbs of various severity for the period 2009-2011. There were diaphyseal fractures of long bones of limbs associated with soft tissue injuries. Men were predominant (80.7%). Age ranged from 15 to 80 years (mean 38,5 ± 5,7 years). Various surgical techniques of simultaneous and staged treatment were used for gunshot fractures of long bones of limbs. Additional immune therapy was prescribed to prevent infectious complications in the most severe cases. RESULTS AND DISCUSSION: Victims were comprehensively treated according to different staged treatment: conventional surgical treatment with external fixation devices or early primary minimally invasive functionally stable osteosynthesis with LCP/BIOS plates were applied for low-energy fractures; in case of high-energy fractures the first stage included external fixation devices deployment followed by their subsequent replacement during delayed minimally invasive osteosynthesis. The essence of improvement is pursuit to simultaneous minimally invasive surgery by using of current plates for osteosynthesis and preventive immunotherapy of immune dysfunction to eliminate infectious complications. As a result, we obtained 2-fold decrease of surgical invasiveness (r≤0,01) and hospital-stay (r≤0,01). Repeated osteosynthesis was not made. Also 4-fold and 40-fold reduction of infectious and noninfectious complications was observed. This management was accompanied by reduced rehabilitation tine and significantly improved quality of life. CONCLUSION: Improved technique and algorithm of complex treatment of diaphyseal gunshot fractures of long bones of limbs were described. Early minimally invasive functionally stable osteosynthesis with modern implants and non-specific immune prevention of infectious complications are more effective and economically justified compared with conventional treatment including external fixation devices without immunoactive therapy.

[Performance evaluation of comprehensive treatment of patients with infectious complications of bullet-extremity fractures].

The objective of the study was to examine the effectiveness of complex treatment of patients with infectious complications of gunshot fractures of limb bones using advanced minimally invasive surgical technologies phased osteosynthesis and new approaches of drug therapy. A prospective, comparative study of the results of examination and treatment of 60 patients with infectious complications of gunshot diaphyseal fractures of the long bones of the limbs treated in hospital Almutavakel (Sana'a, Republic of Yemen) in the period 2009-2011. Patients were randomized and divided into groups depending on the treatment regimen: a comparison (30 patients) received traditional scheme in which only apply external fixation devices or metal obsolete models and basic (30 patients), received treatment for advanced techniques include minimally invasive surgical sanitation of infected fracture zone followed by differentiated (depending on the size of the existing bone defect) tactics of consistent and gradual minimally invasive functionally stable osteosynthesis with modern APS and implants on a background of conservative therapy consisting of Cycloferon. The study showed a high clinical and cost-effectiveness of improved methods compared to traditional, that allows to recommend it for the provision of specialized medical care in the treatment of patients with infectious and complicated gunshot fractures of the long bones of the limbs.