The array of this study is 1069 cases of limb damage due to modern combat
operations, selected from an array of 2120 victims who were taken to the Dnipro
Regional Clinical Hospital. I. Mechnikov during 2014–2016.
The number of armed conflicts and local wars and terrorist acts has recently
become quite frequent (first and second wars in the Chechen Republic of 1994–1996
and 1999–2009, the Georgian conflict of 2008, the antiterrorist operation in the
Donbas 2014 – to date, the war in Syria 2011 – for the present time). Modern
combat operations differ significantly in their intensity, length of the line of
collision, the use of weapons and the means of protection, from the fighting of the
previous century. In modern combat conditions, the number of traumatic amputations of the
extremities increased, the vast majority as a result of blasting and explosive lesions,
and magnumecular wounds (Humananuk Y.K., Samokhvalov I.M.). What if not
giving adequate, in full assistance at all stages in many cases leads to death. Defeat
of the vessels and nerves of the limbs often leads to severe complications and causes
the disability (AN Berkutov). Not to mention purulent-septic complications that lead
to prolonged stay in the hospital, long rehab, and often to disability, which has
consequences for the patient in the physical, moral and psychological aspect, and for
the state in the economic, social and demographic sense. The goal of the work. Determine the clinical and epidemiological and clinical and nosological structure of modern limb traumatic trauma with the use of riskoriented method as the fundamental basis for standardizing the process of providing medical care. It has been established that suffering from extremity damage as a result of modern combat operations, which was assisted at the tactical and early hospital
stage, have rather unusual clinical and epidemiological and clinical and nosological
characteristics, which are decisive in that the majority of them are men of the male
age, working age from 20 to 50 years old, which make up 88.85 % of all victims, which is a significant problem both in the medical and social and in the economic
sphere for the country as a whole. Analysis of the distribution of the victims of the
ratio of direct involvement in hostilities indicates that 98.10 % of the victims are
members of military formations. As to the integral distribution of the array by
military rank, the following data was established that 64,36 % of the victims were
military men with fewer officers and midshipmen, 48.17 % of whom were soldiers.
Analysis of the data of the victims as a result of modern combat operations
found that the most frequently damaged limbs 50.40 %. The vast majority of limb
injuries fall on the lower 62.02 %, which is quite logically taking into account the
influence of the factors of defeat of modern weapons, in the context of modern
combat operations. In general, it should be noted that the first place is damaged as a result of
damage to the explosive wave as a whole 68.97 %. Damage to wreckage of weapons
25.86 % and bullet damage 17.00 %. Thus, the greatest risk of occurrence is the
effect of an explosive wave, meaning the risk of amputation with what depends on
the anatomical sign of the damaged limb. Damage to the elements of the vascular-nervous system of the extremities in the victims as a result of modern military operations is 5,33 %, of which 1,49 % is damage to the vascular-nerve beams, and 3,84 % is the isolated damage to the
artery, nerve or vein. Interesting data on the characteristics of isolated arterial damage by
anatomical sign. Most often the femoral artery is damaged by 40.90 %, the brachial
artery is 31.82 %, the radius 18.18 %, the elbow and the foreskin – 4.55 %.
Having analyzed the immediate causes of amputation by the Clinical Risk Management concept, it can be concluded that only primary traumatic amputation is essential in implementing the overall amputation risk of 0.71, all other causes are negligible and minimal. The implementation of the risk of damage to the limbs on the basis of the mechanism of damage is as follows: the realization of the risk of the resulting mineexplosive mechanism 0,86, ie, catastrophic, ballistic – 0,11 insignificant, and mechanical injury – 0,03 min. The implementation of the risk of damage to the limbs on the basis of the mechanism of damage is as follows: the realization of the risk of the resulting mineexplosive mechanism 0,86, ie, catastrophic, ballistic – 0,11 insignificant, and mechanical injury – 0,03 min.
