Effectiveness of organ–preserving surgical interventions in patients with consequences of mine–blast wounds of the elbow joint

Objective. To improve the results of surgical treatment of patients with combat surgical trauma of the elbow joint. Materials and methods. A retrospective analysis was conducted of the treatment outcomes of 35 patients with mine–blast injuries of the elbow joint sustained during combat operations, which resulted in fractures of the distal metaphysis of the humerus and, in 37.1% of patients, soft tissue defects and damage to nerve structures. All patients underwent organ–preserving reconstructive surgery, which consisted of resection of the false joint area, metal osteosynthesis with special plates, and bone autoplasty using the iliac wing. The degree of bone consolidation was monitored by X–ray and computed tomography at 5, 12, and 16 weeks after surgery. For adequate interpretation of the data, a bone consolidation index was used, which was determined by the area of the bone defect, allowing for more accurate consideration of the characteristics of bone defects in the metaphysis of the humerus. Results. At week 5, partial bone consolidation was observed in 34.3% of patients, minimal signs of consolidation in 45.7%, and no signs of fracture union in 20% of patients. By week 12, partial bone consolidation was achieved in 57.1% of patients, by week 16 in 60%, and complete fracture healing was observed in 11.4% of patients. The bone consolidation index decreased with increasing lesion size: from 0.1891 week/mm² in patients with the smallest defects to 0.0466 week/mm² in patients with the largest defects. Patients with delayed bone consolidation were treated with bone marrow aspirate concentrate, which contributed to positive radiographic dynamics in most of them. Conclusions. The results obtained confirm the feasibility of organ–preserving treatment of gunshot injuries of the elbow joint and the effectiveness of metal osteosynthesis with bone autoplasty in combination with cell technologies.