The object of the research – gunshot fractures of long bones; purpose of study: to increase efficacy of surgical treatment in patients with gunshot fractures of long bones based on clinical experimental rationale of the choice of reasonable extrafocal osteosynthesis methods with regard to biomechanical alterations in bone tissue at gunshot fracture site; methods – clinical, laboratory, instrumental, natural stand-up samples, double-semantic, systemic analysis, analytical, statistical, analytical-synthetic and porous analogue methods; novelty – the method and relevant tools to determine biochemical properties of cortical layer of the long bones before and after gunshot fracture at the different distance from the injury site were developed and substantiated for the first time; based on the results of experimental anatomic and biomechanical studies, scientifically substantiated experimental evidence of shock-wave osteoporosis-like transformation of bone tissue in gunshot fractures were obtained; based on comparative analysis of stiffness properties of “device – fractured long bone” system with standard layout scheme of Schanz screws, with Schanz screws located at larger distance form one another, and with Schanz screws located at the selected angle of 15° and 30°, the design of rod external fixation device was optimized and substantiated with insertion of Schanz screws under specific angle to the bone axis, and the methods of its use; the fixator for Schanz screws was designed for the first time; it makes it possible to arrange them at the angles of 0°, 15°, 30° against perpendicular to longitudinal axis of the system, and to move along the bar with fixation hereto at the site required; algorithm of surgical therapy in patients with gunshot wounds of long bones was substantiated and implemented with regard to biomechanical alterations in the bone tissue; results – the suggested fixation schemes of bone splinters using external fixation device in gunshot fractures may provide improved therapeutic results in patients with gunshot fractures of long bones; the suggested therapeutic algorithm in patients with gunshot wounds of long bones with regard to biomechanical alterations in bone tissue after gunshot fracture may improve therapeutic results in patients with gunshot fractures of long bones; prognostic estimation of the relative risk of the probability of unsatisfactory outcome of treatment based on clinical factors with estimation of informative significance of each as a tool for prediction of the result and its possible correction to achieve maximum effect is proposed; implemented into the educational process for the students at the Ukrainian Military Medical Academy, and into the clinical practice of traumatology departments at the Bakhmut Central District Hospital, Emergency Medical Care Hospital of Mariupol city, City Hospital No. 1 of Mariupol city, military unit А0209; the application area is the medical and diagnostic process of specialized traumatology departments, centers for emergency medical care and disaster medicine, scientific and pedagogical processes of the departments of traumatology and orthopedics, military field surgery, emergency medical care of medical institutions.
