title: [Clinical experience with various techniques integrated treat the wounded with gunshot fractures of limbs].
abstract: OBJECTIVE
  To increase an efficiency of complex treatment of patients with diaphyseal gunshot fractures of long bones by introduction of modern minimally invasive surgical techniques of internal osteosynthesis into clinical practice of civil health care and to improve the outcomes in victims.
  
  
  METHODS
  Prospective comparative clinical trial included 104 victims from the Republic of Yemen with gunshot wounds of limbs of various severity for the period 2009-2011. There were diaphyseal fractures of long bones of limbs associated with soft tissue injuries. Men were predominant (80.7%). Age ranged from 15 to 80 years (mean 38,5 ± 5,7 years). Various surgical techniques of simultaneous and staged treatment were used for gunshot fractures of long bones of limbs. Additional immune therapy was prescribed to prevent infectious complications in the most severe cases.
  
  
  CONCLUSIONS
  Victims were comprehensively treated according to different staged treatment: conventional surgical treatment with external fixation devices or early primary minimally invasive functionally stable osteosynthesis with LCP/BIOS plates were applied for low-energy fractures; in case of high-energy fractures the first stage included external fixation devices deployment followed by their subsequent replacement during delayed minimally invasive osteosynthesis. The essence of improvement is pursuit to simultaneous minimally invasive surgery by using of current plates for osteosynthesis and preventive immunotherapy of immune dysfunction to eliminate infectious complications. As a result, we obtained 2-fold decrease of surgical invasiveness (r≤0,01) and hospital-stay (r≤0,01). Repeated osteosynthesis was not made. Also 4-fold and 40-fold reduction of infectious and noninfectious complications was observed. This management was accompanied by reduced rehabilitation tine and significantly improved quality of life.
  
  
  CONCLUSIONS
  Improved technique and algorithm of complex treatment of diaphyseal gunshot fractures of long bones of limbs were described. Early minimally invasive functionally stable osteosynthesis with modern implants and non-specific immune prevention of infectious complications are more effective and economically justified compared with conventional treatment including external fixation devices without immunoactive therapy.
authors.affiliation: Mechnikov Northwest State Medical University, Saint-Petersburg, Russia; Saint-Petersburg State University; Yaroslav Mudryi Novgorod State University, Velikiy Novgorod, Russia.
authors.forename: V K
authors.initials: VK
authors.lastname: Kozlov
authors.affiliation: Vishnevsky Surgery Institute, Moscow, Russia.
authors.forename: B G
authors.initials: BG
authors.lastname: Akhmedov
authors.affiliation: Vishnevsky Surgery Institute, Moscow, Russia.
authors.forename: A M
authors.initials: AM
authors.lastname: Chililov
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy / Q000379:methods; D018483:Diaphyses / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D005121:Extremities / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D050723:Fractures, Bone / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006801:Humans; D056747:Immunomodulation / Q000276:immunology*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D013530:Surgical Wound Infection / Q000276:immunology / Q000517:prevention & control; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000150:complications*; D015006:Yemen