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Background: In the conditions of modern armed conflicts, limb injuries still prevail in the structure of combat sanitary losses, accounting for 55% to 75% of their number. For a long time in our country, the method of percutaneous compression-distraction osteosynthesis according to G.A. Ilizarov has been used to treat this category of patients. However, in the current conditions of mass admission of the wounded to the central military medical organizations, there is a need to improve the quality and shorten the duration of their treatment. One of the ways to optimize treatment is the use of successive internal osteosynthesis. And the introduction of internal fixators with antibacterial coating reduces the number of infectious complications during sequential osteosynthesis.

Aim: To analyze, based on our clinical experience and data from the world literature, the effectiveness of the method of sequential osteosynthesis in the treatment of wounded with gunshot fractures of long limb bones in the current armed conflict.

Materials and methods: The work is based on the analysis of the treatment results of 320 patients with upper and lower limb injuries who were receiving specialized medical care at the Traumatology and Orthopedics Center of the Main Military Clinical Hospital named after N.N. Burdenko of the Ministry of Defense of the Russian Federation. Depending on the osteosynthesis technique used, the patients were divided into three groups. All patients were male, aged 18 to 59 years, their average age was 32.2±9.02 years. All patients underwent stage radiographs after osteosynthesis. The functional outcome of treatment for humeral fractures was assessed using the DASH scale, and the functional outcome for femur and tibia fractures was assessed using the Neer-Grantham-Shelton scale.

Results: There were 90 (28.125%) patients with fractures of the humerus, and 230 (71.875%) patients with injuries of the lower extremities accompanied by fractures of the femur and tibia. Shrapnel wounds and/or explosive injuries prevailed in 288 wounded (90%). When comparing groups of patients with each other, it was noted that the use of internal implants with antibacterial coating significantly (p <0.0167) reduces the time of transition from external fixation to internal fixation, as well as reduces the risk of infectious complications.

Conclusion: Sequential osteosynthesis has proven itself as a two-stage method of treating wounded patients with fractures of long bones of the extremities and in the conditions of modern armed conflict is considered as the main method of treating isolated and multiple uncomplicated gunshot fractures with strict adherence to certain recommendations. In addition, at the current stage of development of traumatology and orthopedics, there is a possibility of using implants with antibacterial coating, which reduces the risk of infectious complications.