Results of treatment of massive dhaphysal defects of the femor after gunshot wounds using additive technologies

The problem of replacing femoral defects after gunshot fractures is one of the most diffi ult in traumatology and orthopedics.Th purpose of the study was to compare the results of surgical treatment of patients with gunshot defects of the femoral diaphysis using additive technologies and the method of compression-distraction osteosynthesis according to Ilizarov.Material and methods. During the period from 2019 to 2023, a prospective single-center sequential controlled study was conducted, which included twenty wounded patients with gunshot circular defects of the middle third of the femoral diaphysis (more than 7 cm). The main group (I - 8 wounded) had femoral defects replaced using additive technology - an individually manufactured implant filled with auto- and allograft and fi ed with a locking intramedullary pin; the control group (II - 12 wounded) had femoral defects replaced using the compression-distraction method osteosynthesis according to Ilizarov. The age of the patients was 29.3±3.3 years, the size of the bone defect was 9.8±2.4 cm. The severity of the condition on the VHS-SP scale was estimated at an average of 12.2±1.5 points.Results. The duration of inpatient treatment for patients in group I was significantly shorter compared to group II: 62.1±12.7 and 112.0±37.0 days, respectively. The average time for anatomical restoration or integration of a 3-D implant for 7 patients in group I who completed treatment with a positive result was170.9 ± 19.7 days. While in group II, replacement of the defect with bone transport and fusion of fragments was achieved after 275.7±76.7 days. The return of the wounded to the previous level of physical activity and to military service without changing the fitness category was achieved in 5 (62.5%) people out of 8 in group I and in 7 (58.3%) out of 12 in group II - the differences are not statistically signifi ant. According to the LEFS scale, a more rapid and complete recovery was observed in group I compared to group II: after 12 months, these indicators increased to 70.9±6.1 and 61.43±6.9 points, respectively.