Keywords
gunshot fractures
combat trauma
scapula
clavicle
shoulder joint
multi-structural trauma
surgical treatment
reconstructive and restorative surgery
How to Cite
Abstract
Introduction. According to various studies, limb injuries caused by combat trauma account for 44% to 70% of all injuries to musculoskeletal system.
Objective. This study aims to analyze shoulder girdle injuries in patients with combat-related surgical trauma who underwent surgical treatment.
Materials and Methods. A retrospective analysis was conducted on 733 patients with combat-related surgical trauma of the limbs, including 378 patients (51.6%) with upper limb injuries and 355 patients (48.4%) with lower limb injuries. All patients received inpatient treatment at the Department of Severe Skeletal Trauma of the State Institution «Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine» from August 1, 2022, to December 31, 2024.
Results. During this period, surgical treatment was performed in 63 patients with shoulder girdle combat-related surgical trauma, accounting for 8.6% of all limb injuries and 16.7% of upper limb injuries. The mean age of patients was 34.7±8.1 years. By injury type, gunshot wounds were observed in 35 patients (55.6%), mine-blast injuries in 13 patients (20.6%), other injuries in 8 patients (12.7%), shrapnel wounds in 4 patients (6.3%), and road traffic accident (RTA) injuries in 3 patients (4.8%). Fractures were classified into three groups: fractures and dislocations involving the clavicle in 28 patients (44.4%), scapular fractures in 17 patients (27.0%), and combined fractures of the clavicle and scapula in 18 patients (28.6%). Bone defects were observed in 43 patients (68.3%), with a mean defect length of 4,7±3,8 cm. Gunshot wounds to soft tissues involving shoulder girdle muscles and tendons were found in 54 patients (85.7%). Nerve injuries were diagnosed in 14 patients (22.2%). Major vascular injuries requiring surgical intervention, according to accompanying documentation, were found in 3 patients (4.8%).
Conclusions. The analysis of combat-related shoulder girdle injuries demonstrated a high incidence of multi-structural injuries, particularly among working-age males (96.8%), requiring complex surgical interventions and prolonged rehabilitation. The most common injuries were fractures of the clavicle (44.4%) and scapula (27.0%), along with soft tissue injuries involving muscles (85.7%) and nerves (22.2%), which significantly complicate treatment and rehabilitation.
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