The role of x-ray research methods in evaluating the use of sequential osteosynthesis in explosive limb injuries

Relevance. Injuries sustained during combat operations in modern conditions are characterized by a significant degree of tissue destruction and contamination, and have nothing to do with what is observed in peacetime injuries. This is convincingly confirmed by statistical data on the conduct of a special military operation (SVO), published in the medical literature. The use of radiation research methods in explosive lesions with limb damage is the basis for determining the degree of damage, establishing a correct diagnosis and evaluating the use of osteosynthesis.

Purpose. To determine the importance of classical digital radiography in the diagnosis of limb injuries in explosive injuries at the stage of specialized medical care, both during the initial examination of the wounded and during sequential osteosynthesis.

Materials and methods. The medical histories and 854 X-ray examinations of 110 victims with explosive limb injuries were retrospectively analyzed. Radiographs were evaluated before and after osteosynthesis, when changing the type of osteosynthesis, during dynamic monitoring and the occurrence of complications. All the wounded were men, with an average age of 34.8±7.7 years.

Results. When analyzing the data, it was revealed that lower extremities are more often damaged by modern weapons – 61.21%, namely fractures of the shin bones – 29.09%. Radiographs revealed the following complications: gunshot osteomyelitis, false joint – in 14.5% of cases. The occurrence of a relatively small number of complications is associated with a large number of wounded (31.48%) who were admitted to the hospital from 2 to 7 days after receiving wounds. 2.7% had osteomyelitis and the formation of a false joint. Delayed consolidation during fixation by various types of metallosynthesis was observed in 86.36% of the injured. Osteomyelitis was suspected by X–ray in 7.27% of the injured, confirmed by computed tomography (CT) (62.5%), confirmed by fistulography (50%). In 10% of the victims, a false joint was detected on X-rays, and the presence of a false joint was confirmed by CT in 54.54% of the victims.

Conclusion. Classical digital radiography is a basic study and cannot be replaced with intraoperative radiotherapy to perform osteosynthesis, as well as to assess the dynamics of the wound process of bone structures of the limb under conditions of fixation by various types of osteosynthesis. However, there are limitations of the method, and CT is additionally used to reliably assess the condition of bone and soft tissue structures.

1. 1 Mischuk A.S., Sazonova D.M., Domarev M.A. Modern methods of treating mine-explosive injuries received in combat conditions. Young Scientist. 2024;21(520):33-36. (In Russ.). URL: https://moluch.ru/archive/520/114632

2. 2 Ovchinnikov D.V., Ivchenko E.V. Military Medicine of Modern Hybrid Wars. Izvestiya of the Russian Military Medical Academy. 2024; 43(3):331- 340. (In Russ.). URL: https://journals.ecovector.com/RMMArep/article/view/633158?ysclid=miee5jgnqm948831276

3. 3 Seliverstov P.A., Shapkin Yu.G. Application of Damage Control Tactics in Combat Limb Inju ries at the Advanced Stages of Medical Evacuation in Modern Wars (Literature Review). Medical, Biological, and Social-Psychological Issues of Safety in Emergency Situations. 2023;(1):42-52. (In Russ.). URL: https://mchsros.elpub.ru/jour/article/view/900

4. 4 Dorokhov A.E. Analysis of the nature of injuries and wounds received during a special military operation. Youth Innovation Bulletin. 2023.12(S2):138-140. (In Russ.). URL: https://scinetwork.ru/articles/13784

5. 5 Yunusov I.A., Shaimonov A.Kh., Kurbanov S.Kh., Rustamzoda Kh.M., Sharipov M.A., Jafarov A.Kh. Modern Aspects of Treatment of Gunshot Fractures of Long Bones. Medical Bulletin of the National Academy of Sciences of Tajikistan. 2020.3(35). (In Russ.). URL: https://cyberleninka.ru/article/n/sovremennye-aspekty-lecheniyaognestrelnyh-perelomov-dlinnyh-kostey

6. 6 Gubar L.M. The importance of X-ray diagnostics in gunshot wounds of the bones of the extremities. Modern issues of radiation and environmental medicine, radiation diagnostics and therapy: collection of materials of the Republican scientific and practical conference with international participation. 2019:56-62. (In Russ.). URL: http://elib.grsmu.by/handle/files/16316?show=full

7. 7 Gunshot wounds and limb injuries. Medical care and treatment at the stages of medical evacuation: a textbook. V.V. Yurkevich [et al.]; edited by T.B. Komkova. 2024:114. (In Russ.). URL: https://elar.ssmu.ru/bitstream/20.500.12701/4401/1/tut_ssmu-2024-34.pdf

8. 8 Military Field Surgery. National Manual; edited by I.M. Samokhvalov. 2024: 1056. (In Russ.). URL: https://www.geotar.ru/lots/NF0026604.html?ysclid=miefjw967a306662705

9. 9 Polushin Yu.S. Explosive Injuries (Lecture). Bulletin of Anesthesiology and Resuscitation. 2022;19(6):6-17. (In Russ.). URL: https://www.vairjournal.com/jour/article/view/732?ysclid=miefp1itqo325802630

10. Gasymov Kh.R. Algorithm for providing specialized care to wounded patients with fractures of the extremities and damage to the vascular-nervous bundle. Izvestiya of the Russian Military Medical Academy. 2020 (In Russ.). URL: https://www.vmeda.org/wp-content/uploads/2020/11/page-05-07-journal-2020-39-1-1.pdf

11. 11 Trukhan A.P. Firearm Wounds and Peacetime Explosive Trauma. Features, Organization, and Provision of Surgical Care (Clinical and Experimental Research). 2022:258. (In Russ.). URL: https://vmeda.mil.ru/upload/site56/document_file/Tekst_dissertacii(215).pdf?ysclid=miefu4pgga951792470

12. 12 Khatri J.P., et al. Primary internal fixation in open fractures of tibia following high-velocity gunshot wounds: a single-centre experience. Int Orthop. 2020. URL: https://pubmed.ncbi.nlm.nih.gov/31392496

13. 13 Warkentien TE, Lewandowski LR, Potter BK, Petfield JL, Stinner DJ, Krauss M, Murray CK, Tribble DR; Trauma Infectious Disease Outcomes Study Group. Osteomyelitis Risk Factors Related to Combat Trauma Open Upper Extremity Fractures: A Case-Control Analysis. J Orthop Trauma. 2019;33(12). URL: https://pubmed.ncbi.nlm.nih.gov/31356447

14. 14 Naumov A.V. Improvement of Requirements for Mobile Field X-Ray Systems. Izvestiya of the Russian Military Medical Academy. 2019;38(4):108-110. (In Russ.). URL: https://medj.rucml.ru/journal/45562d524d4d415245502d41525449434c452d3236303333?ysclid=miekdfzqh370922895

15. 15 Lee C., Brodke D.J., Engel J., Schloss M.G., Zaidi S.M. R., O’Toole R. V., Gulbrandsen T., Hogue M., Badon J., Bergin P.F., Lirette S.T., Morellato J. Lowenergy Gunshot-induced Tibia Fractures: What Proportion Develop Complications? Clin Orthop Relat Res. 2021. URL: https://pubmed.ncbi.nlm.nih.gov/33760776

16. 16 Batseko A.S. X-ray characteristics of foreign bodies in gunshot and blast injuries. Congress of the Russian Society of X-ray and Radiological Specialists: collection of abstracts. St. Petersburg Public Organization "Man and His Health". 2023:22. (In Russ.). URL: https://cdn.congressph.online/79/material.pdf

17. Atlas of Styling for X-Ray Examinations / A.N. Kishkovsky, L.A. Tyutin, and G.N. Esinovskaya. Leningrad: Meditsina, Leningrad Branch, 1987:519. (In Russ.).