115-years Anniversary Sytenko Institute of Spine and Joint Pathology, National Ukrainian Academy of Medical Science

With a beginning of active battle actions in Ukraine the number of victims with gunshot, mine-explosive and shrapnel injuries of the locomotor system among both the military and the civilian population increased sharply. Therefore, the problems of treatment and rehabilitation of victims of hostilities have become especially acute in the last year. Aim. To analyze literary sources on the issue of providing medical aid for gunshot injuries of the musculoskeletal system, to identify problems and prospective directions of rehabilitation treatment of the consequences of combat trauma. Methods. An analytical review of scientific works on the treatment of gunshot and mine-explosive injuries of the musculoskeletal system and their consequences was conducted. Results. It is shown that in recent decades, as a result of the creation of modern firearms and explosive shells, the scale and severity of traumatic injuries have increased significantly, and the frequency of multiple and combined injuries has also increased. Fire injuries of the musculoskeletal system are accompanied by many complications and unsatisfactory anatomical and functional results of treatment. Such injuries are characterized by a traumatic disease that develops in response to combat trauma and has a long and complicated course, high rates of mortality and severe disability. Extremity injuries are the most common — 65‒75 %, and in some combat operations — 80 % or more. The most serious injuries include mine-explosive injuries, which are accompanied by massive damage to the soft tissues of the limbs, main vessels and nerves, and the development of compartment syndrome. 19.1–52.9%) and permanent disability. Conclusions. Damages of the spine and spinal cord lead to high mortality (19.1–52.9 %) and permanent disability. Conclusions. Despite the significant number of developed restorative treatment and rehabilitation technologies victims with gunshot and mine-explosive injuries, specialists continue to improve methods of physical rehabilitation, and work on eliminating problems and shortcomings that still exist in the organization of rehabilitation measures.

The problem of long bones fractures treatment remains actual, despite a significant number of studies carried out on this topic. Such fractures of the musculoskeletal system occur more often and are accompanied by various complications, significantly compromise the quality of patients life and often lead to the disability. Objective. To analyze different types of traumatic injuries in patients with the consequences of long bone fractures, to evaluate the effectiveness of diagnostics, treatment and to analyze the state of disability. Methods. A retrospective medical and social analysis of the results of treatment of 333 patients (232 (69.6 %) men, 101 (30.4 %) women) with the consequences of long bone fractures, based on the obtained study group in the Kharkiv Regional Center for Medical and Social Expertise № 2, for the period 2018–2019. Results. Three main methods of surgical treatment were analyzed: internal fixation (ORIF), blocking intramedullary nailing (IMN) and treatment with external fixation devices (EF). They were applied in the following rate: ORIF — 204 (61.3 %) cases, IMN — 98 (29.4 %), EF — 31 (9.3 %). The most typical complications of the treatment of patients with fractures of the long bones were delayed union or nonunion, neuropathies of the treated extrimities, joint contractures, osteoarthritis of adjacent joints, deformities of affected extrimities, osteomyelitis. Causes of disability were: 63 % — severity of injuries, 46 % — different posttraumatic complications, 6.5 % — iatrogenic complications. Among the latter, the most common were: diagnostic — 7.1 %, incorrect method of treatment — 29.7 %, iatrogenic incorrect surgery methods — 45 %. Conclusions. The data obtained showed that the improvement of organization measures for the prevention of complications and disability in patients with consequences of long bones fractures could help to increase the efficiency and quality of specialized medical help. Key words. Fractures, long bones, limbs, consequences, complications, disability.

The problem of treating fractures of the long bones of the limbs (FLB) does not lose its relevance, since among all injuries of the locomotorsystem, they occur most often and are accompanied by various complications. According to the literature, in 38 % of patients,disability from injuries of the locomotor system is due to its functional disorders, and in most cases it can be prevented by followingthe correct rehabilitation measures. Objective. To analyze and determine the most important factors for the formation of a rehabilitationprogram for patients with FLB and to evaluate the effectiveness of these measures. Methods. A medico-social analysisof the results of treatment of 63 patients (41 men and 22 women) with FLB, including those with flammability, who received treatmentat the «Sitenko Institute of Spine and Joint Pathology NAMS of Ukraine» in 2020‒2021. Of them, 63.5 % had multiple injuries,in 2020 — 64.3 %, in 2021 — 62.8 %. The results. The clinical and functional state of the patients was analyzed, taking into accountthe nature of the injury and the location of the fractures, depending on the level of rehabilitation potential. The main organizationalprinciples of providing medical assistance and rehabilitation to victims of FLB have been defined and formulated. The rehabilitationgroups of patients are characterized, the main factors affecting the rehabilitation potential and rehabilitation prognosis are determined.The main principles that must be taken into account when drawing up an individual rehabilitation program for patients withFLB are formulated. Conclusions. The conducted studies showed that the proposed principles of creating a medical rehabilitationprogram for patients with fractures of the long bones of the limbs made it possible to more objectively substantiate the scope andterms of restorative treatment at all stages of rehabilitation and specify the structure of rehabilitation measures for every case, that,finally, made it possible to develop individual rehabilitation programs for these patients and improve the results of their treatment.

Blast injury (BI) is a combat multifactorial injury resulting from the impulse action of the complex traumatic factors by the mine munition explosion, characterized an interconnected and increasingly severe impact, massive deep tissue damage and the development of a general contusion-shock syndrome. For severe BI with large skin and soft tissue defects, it is advisable to use negative pressure wound therapy (NPWT). Objective. To analyze the effectiveness of using the NPWT system in patients with blast injuries. Methods. Publications were searched in electronic systems Google Scholar, PubMed, ScienceDirect, archives of specialized journals. The results of treatment using NPWT of 134 patients were analyzed: 130 (97 %) men and 4 (3 %) women, average age 36.6 years (22‒64). According to the types of injuries, the patients were distributed as follows: blast injury — 128 (95.5%), bullet injuries — 6 (4.5 %). The results. The goal of BI treatment by negative pressure is to improve wound healing through multiple mechanisms of action at the macroscopic and microscopic levels. The use of NPWT reduces the risk of infectious complications, prevents excessive progression necrosis of affected tissues, accelerates the growth of granulation tissues and reduces pain syndrome. The result of the treatment is the wound preparation for primary healing or, in the case of significant soft tissue damage, the creation of favorable conditions for performing plastic surgeries. In general, NPWT accelerates treatment times, reduces risks of complication level and improves functional results. This current own research coincides with the results of majority authors and allows us to continue work in this direction. Conclusions. Treatment of blast injury wounds with the use of vacuum bandages and devices for creating negative pressure is an effective approach that contributes to the reduction of infectious complications, the growth of granulation tissue, facilitates further skin plasticity of the defect, accelerates the recovery time of the wounded and his rehabilitation.