Differentiated Approach to Surgical ­Treatment of Gunshot Diaphyseal Shin Fractures

Background. The roots of problems in the treatment of gunshot fractures to extremities lay in the high-energetic character of these traumas, the frequency of infectious complications, high rate of slow consolidations, and occurrence of pseudoarthroses and bone tissue lesions. Objective. The objective of the study was to improve the treatment results of patients with gunshot fractures of the shin bones based on the development of a differentiated approach to the treatment of such injuries. Material and Methods. The study is based on the results of examination and treatment of 128 patients with dominant combat shin traumas. The patients were divided into two groups. The first group (control group) included 68 patients who underwent treatment with an external fixation device (EFD). The second group (study group) included 60 patients who underwent the extrafocal osteosynthesis replaced by an internal, mostly intramedullary one. To assess the functional outcomes of treatment, we applied the LEFS (Lower Extremity Functional Scale) in the dynamics of the therapy, namely in 3, 6, 12, and 18 months after the injury. Results. Mean values in both groups during the first two to three weeks showed no statistically significant difference, and their average score according to the LEFS scale was 15.75 points. The most significant differences were observed in the period from 6 to 12 months after the injury, 39.4±2.4 (EFD) and 57.3±2.1 (intramedullary nailing). After 18 months, excellent results showed 20.7% of patients from the study group and 15.8% of the control group (61 – 80 LEFS scores). Good results had 43.2% and 33.1%, respectively (41 – 60 LEFS scores). 28.1% and 39.3%, respectively, showed satisfactory results (21 – 40 LEFS scores). Poor results showed 8.0% of patients of the study group and 11.8% of the control group (p<0.05). Conclusions. The analysis of treatment outcomes of patients with gunshot diaphyseal shin fractures demonstrates that conversion, when used according to indications and following criteria to the replacement of the method of fixation, reduces the incidence of complications in both the early and late postoperative periods, fastens consolidation of gunshot diaphyseal shin fractures by 4.5±2.3 weeks, reduces the frequency of fracture consolidation disorders by 10.6%, and improves the functional results of the patients by 15.0%.