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.