Email this article Sequential osteosynthesis in the context of modern armed conflicts
- Authors: Kerimov A.A.1, Khominets I.V.1, Perekhodov S.N.2, Kozlov N.S.2, Bekshokov K.K.3, Nelin M.N.1, Kukushko E.A.1, Besedin V.D.1, Tverdokhlebov S.I.4, Kozelskaya A.I.4
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Affiliations:
- Main Military Clinical Hospital named after N.N. Burdenko
- Russian University of Medicine
- Peoples’ Friendship University of Russia
- National Research Tomsk Polytechnic University (Tomsk Polytechnic University)
- Issue: Vol 32, No 2 (2025)
- Pages: 325-335
- Section: Original study articles
- URL: https://ogarev-online.ru/0869-8678/article/view/314741
- DOI: https://doi.org/10.17816/vto643121
- EDN: https://elibrary.ru/YVRMAJ
- ID: 314741
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Abstract
BACKGROUND: Limb injuries remain the most prevalent combat injuries in modern armed conflicts, accounting for 55% to 75% of all cases. The transosseous compression-distraction osteosynthesis technique developed by Ilizarov has long been used in Russia to treat this patient population. However, given the current rate of mass casualty admissions to central military medical facilities, there is a growing need to improve treatment quality while shortening treatment time. Sequential internal osteosynthesis is one way for improving care. Antibiotic-coated implants reduce the risk of infectious complications during sequential osteosynthesis.
AIM: This study aimed to assess the efficacy of sequential osteosynthesis in the treatment of gunshot fractures of long bones of the limbs in the current armed conflict setting, based on our clinical experience and global scientific data.
METHODS: The study is based on an analysis of treatment outcomes in 320 patients with upper and lower limb injuries who received specialized medical care at the Department of Traumatology and Orthopedics of the N.N. Burdenko Main Military Clinical Hospital, Ministry of Defense of the Russian Federation. Patients were divided into three groups based on the osteosynthesis technique used. All patients were male, aged 18 to 59 years, with a mean age of 32.2 ± 9.02 years. Stepwise X-ray examinations were performed in all patients following osteosynthesis. Functional outcomes of humeral fracture treatment were assessed using the DASH score, whereas functional outcomes of femoral and tibial fracture treatment were evaluated using the Neer–Grantham–Shelton scale.
RESULTS: The study included 90 patients (28.125%) with humeral fractures and 230 patients (71.875%) with lower limb injuries associated with femoral or tibial fractures. Shrapnel wounds and/or blast injuries predominated in 288 cases (90%). An intergroup comparison showed that antibiotic-coated implants significantly (p < 0.0167) accelerated the transition from external to internal fixation and reduced the risk of infectious complications.
CONCLUSION: Sequential osteosynthesis has proven to be an effective two-stage treatment for long bone fractures in wounded individuals. In the context of modern armed conflict, it is considered the primary approach to managing isolated and multiple uncomplicated gunshot fractures, provided that established guidelines are strictly followed. Furthermore, given the recent advances in traumatology and orthopedics, antibiotic-coated implants can be used to reduce the risk of infectious complications.
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##article.viewOnOriginalSite##About the authors
Artur A. Kerimov
Main Military Clinical Hospital named after N.N. Burdenko
Email: kerartur@yandex.ru
ORCID iD: 0000-0001-5783-6958
SPIN-code: 3131-1308
MD, Cand. Sci. (Medicine)
Russian Federation, 3 Gospitalnaya pl., Moscow, 105094Igor V. Khominets
Main Military Clinical Hospital named after N.N. Burdenko
Author for correspondence.
Email: khominets24_91@mail.ru
ORCID iD: 0000-0003-0964-653X
SPIN-code: 5928-5370
MD, Cand. Sci. (Medicine)
Russian Federation, 3 Gospitalnaya pl., Moscow, 105094Sergey N. Perekhodov
Russian University of Medicine
Email: PEREKHODOV-SN@msmsu.ru
ORCID iD: 0000-0001-7166-0290
SPIN-code: 8770-6877
MD, Dr. Sci. (Medicine), Professor
Russian Federation, MoscowNikolay S. Kozlov
Russian University of Medicine
Email: meddikk@yandex.ru
ORCID iD: 0000-0002-0873-1380
SPIN-code: 5118-9215
MD, Cand. Sci. (Medicine), Associate Professor
Russian Federation, MoscowKazbek K. Bekshokov
Peoples’ Friendship University of Russia
Email: kazbek.bekshokov.99@mail.ru
ORCID iD: 0000-0002-2667-341X
SPIN-code: 8906-6553
MD, resident
Russian Federation, MoscowMaksim N. Nelin
Main Military Clinical Hospital named after N.N. Burdenko
Email: nelinmaksimdoc@gmail.com
ORCID iD: 0009-0000-0198-7693
SPIN-code: 5143-3630
MD
Russian Federation, 3 Gospitalnaya pl., Moscow, 105094Evgeniy A. Kukushko
Main Military Clinical Hospital named after N.N. Burdenko
Email: doctrauma87@gmail.com
ORCID iD: 0000-0002-2941-9601
SPIN-code: 6736-1323
MD
Russian Federation, 3 Gospitalnaya pl., Moscow, 105094Vladimir D. Besedin
Main Military Clinical Hospital named after N.N. Burdenko
Email: BesedinVD@yandex.ru
ORCID iD: 0000-0001-9087-1421
SPIN-code: 9908-6830
MD
Russian Federation, 3 Gospitalnaya pl., Moscow, 105094Sergey I. Tverdokhlebov
National Research Tomsk Polytechnic University (Tomsk Polytechnic University)
Email: tverd@tpu.ru
ORCID iD: 0000-0002-2242-6358
SPIN-code: 9005-9207
Cand. Sci. (Physics and Mathematics), Associate Professor
Russian Federation, TomskAnna I. Kozelskaya
National Research Tomsk Polytechnic University (Tomsk Polytechnic University)
Email: kozelskayaai@tpu.ru
ORCID iD: 0000-0003-0168-0952
SPIN-code: 7317-8713
MD, Cand. Sci. (Medicine), Associate Professor
Russian Federation, TomskReferences
- Trishkin DV, Kryukov EV, Davydov DV, et al. Development of the concept of providing medical care to the wounded with injuries of the musculoskeletal system in modern conditions. Military Medical Journal. 2024;345(5):4–11. doi: 10.52424/00269050_2024_345_5_4 EDN: TALTJH
- Esipov AV, Sukhorukov AL, Musailov VA, et al. The magnitude and structure of isolated limb wounds in modern local conflicts (Literature review). Military Medical Journal. 2023;344(3):33–39. doi: 10.52424/00269050_2023_344_3_33 EDN: IOTYEX
- Kryukov EV, Davydov DV, Khominets VV, et al. Stage-by-stage treatment of the wounded with injuries of the musculoskeletal system in modern armed conflict. Military Medical Journal. 2023;34(3):4–17. doi: 10.52424/00269050_2023_344_3_4 EDN: HWUCXD
- Chandler H, MacLeod K, Penn-Barwell JG; Severe Lower Extremity Combat Trauma (SeLECT) Study Group. Extremity injuries sustained by the UK military in the Iraq and Afghanistan conflicts: 2003–2014. Injury. 2017;48(7):1439–1443. doi: 10.1016/j.injury.2017.05.022
- Khominets VV, Shapovalov VM, Mikhailov SV, Brizhan LK. Treatment of wounded in limbs in wars and armed conflicts. Monograph. St. Petersburg: Historical Illustration; 2021. 304 p. EDN: IUQQOX
- Shchukin AV. Improvement of sequential osteosynthesis in the treatment of wounded with gunshot fractures of long limb bones [dissertation]. 2018. 197 p. (In Russ.). EDN: CVGYII
- Kozelskaya AI, Früh A, Rutkowski S, et al. Antibacterial double-layer calcium phosphate/chitosan composite coating on metal implants for tissue engineering. Colloids and Surfaces A: Physicochemical and Engineering Aspects. 2025;705(2). doi: 10.1016/j.colsurfa.2024.135652
- Fox JP, Markov NP, Markov AM, et al. Plastic surgery at war: a scoping review of current conflicts. Military medicine. 2021;186(3–4):e327–e335. doi: 10.1093/milmed/usaa361
- Gritsyuk AA. Reconstruction and plastic surgery of combat injuries of limbs [dissertation]. Moscow, 2006. 43 р. (In Russ.). EDN: QEAXNN
- Ivanov PA, Sokolov VA, Bialik EI, et al. The use of intramedullary interlocked pins with an active antibacterial coating in the treatment of severe open fractures and their complications. Bulletin of Traumatology and orthopedics named after N.N. Priorov. 2009;(1):13–18. EDN: KCKVMJ
- Solanki T, Maurya MK, Singh PK. Results of Antibiotic-Impregnated Cement/Polymer-Coated Intramedullary Nails in the Management of Infected Nonunion and Open Fractures of Long Bones. Cureus. 2023;15(8). doi: 10.7759/cureus.43421
- Thonse R, Conway J. Antibiotic cement-coated interlocking nail for the treatment of infected nonunions and segmental bone defects. J Orthop Trauma. 2007;21(4):258–68. doi: 10.1097/bot.0b013e31803ea9e6
- Vargas-Hernández JS, Sánchez CA, Renza S, Leal JA. Effectiveness of antibiotic-coated intramedullary nails for open tibia fracture infection prevention. A systematic review and meta-analysis. Injury. 2023;54 Suppl 6:110857. doi: 10.1016/j.injury.2023.110857
- Volotovsky PA, Sitnik AA, Tapalsky DV, et al. The immediate results of the clinical application of a blocked intramedullary fixator with a three-component antibacterial coating for infected fractures and non-joints of long tubular bones. News of surgery. 2020;28(6):680–687. EDN: CBTFDR
- Gutha Y, Pathak JL, Zhang W, Zhang Y, et al. Antibacterial and wound healing properties of chitosan/poly (vinyl alcohol)/zinc oxide beads (CS/PVA/ZnO). Int J Biol Macromol. 2017;103:234–241. doi: 10.1016/j.ijbiomac.2017.05.020
- Artemyev AA, Kerimov AA, Peredonov SN, et al. Sequential external osteosynthesis of gunshot fractures of limb bones at the stages of medical evacuation. Medical Bulletin of the N.N. Burdenko State Medical University. 2023;(1):22–31. doi: 10.53652/2782-1730-2023-4-1-22-31 EDN: YALOZN
- Yudin KA. Sequential osteosynthesis in the treatment of wounded with gunshot fractures of the long bones of the lower extremities. Izvestia of the Russian Military Medical Academy. 2019;38(S1–2):283–285. EDN: ZZJAXJ
- Alavi M, Nokhodchi A. An overview on antimicrobial and wound healing properties of ZnO nanobiofilms, hydrogels, and bionanocomposites based on cellulose, chitosan, and alginate polymers. Carbohydr Polym. 2020;227:115349. doi: 10.1016/j.carbpol.2019.115349
- Ghaseminejad-Raeini A, Azarboo A, Pirahesh K, et al. Antibiotic-Coated Intramedullary Nailing Managing Long Bone Infected Non-Unions: A Meta-Analysis of Comparative Studies. Antibiotics (Basel). 2024;13(1):69. doi: 10.3390/antibiotics13010069
- Rashki S, Asgarpour K, Tarrahimofrad H, et al. Chitosan-based nanoparticles against bacterial infections. Carbohydr Polym. 2021;251:117108. doi: 10.1016/j.carbpol.2020.117108
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