Treatment of gunshot fractures of the tibia: results of one-stage wound closure and sequential osteosynthesis

The work is devoted to the study of medium-term results of treatment of gunshot fractures of the tibia in combination with an extensive soft tissue wound by delayed one-stage wound closure and sequential intramedullary osteosynthesis.Materials and methods. A retrospective and prospective study was conducted, two groups of 8 patients each, who had a gunshot wound with an extensive wound and a fracture of both bones of the lower leg (III A and III B Gustilo-Anderson, 1984). All patients were male, of working age from 27 to 47 years(mean age 36.1±6.6), mean BMI 26.0±1.4 kg/m2, mean follow-up after treatment was 3.3±1 .0 years. In a retrospective study, the results of a two-stage approach to wound closure and subsequent intramedullary osteosynthesis of the tibia were analyzed; in a prospective study, the results of a one-stage approach were analyzed. The number of complications, the timing of fracture healing, and the functional outcome were assessed.Results There were no complications in the treatment of patients of both groups. The average period of fracture union in group I was 9.4±1.5 months, in group II 8.5±1.2 months, which is 9.6% less (p=0.219). Functional results were higher in patients of the second group (4.1±0.8 points) than in the first (3.6±1.2 points) by 12.2% (p=0.348).Conclusion. One-stage replacement of gunshot defects of the soft tissues of the lower leg and intramedullary osteosynthesis of the tibia create favorable conditions for the healing of the fracture, reducing the duration of treatment, restoring weight-bearing capacity and returning the wounded to work.