Object: structural and functional disorders in case of multiple fractures of long bones and combat injuries of the musculoskeletal system. Aim: to improve the treatment of patients with multiple fractures of long bones by developing a system of recovery treatment and rehabilitation on the basis of a differentiated approach to the definition of treatment tactics, a comprehensive assessment of the patient's condition, the phases in the provision of medical care, the introduction of modern surgical techniques. Methods: clinical, laboratory, radiological methods (X-ray, computer tomography), ultrasound (dopplerography), bacteriological, histomorphological, statistical. The concept of restorative treatment of patients with multiple fractures of long bones with the identification of stages (levels) of care and the direction of optimization of therapeutic measures was developed. For patients with multiple open (gunshot and non-gunshot) fractures of long bones at the treatment stages the technology of wound healing, which containing wound preservation, negative pressure therapy and ultrasonic cavitation, was substantiated. The design and justification of applying of pneumatic membranes for transport immobilization of the lower extremities has been developed. Firstly, the applying of a hinge-distraction apparatus for external fixation on the base of rods was developed and biomechanically substantiated, which enables to conduct the trajectory of rotation in the knee without necessity of the axial knitting in the case of ipsilateral fractures of the long bones of the lower limb. The concept and validated terms for the conversion of osteosynthesis method in patients with multiple long-bone fractures were developed, that based on clinical, laboratory and instrumental research methods (patent No. 114667 Ukraine). The choice of matrices based on platelet-rich fibrin to optimize reparative regeneration in the case of filling defects in bone tissue was justified experimentally. The concept of treating patients with multiple fractures of long bones and bone defects with the use of regenerative technologies, modern methods of osteosynthesis based on the methodology of conversion of treatment methods was developed. The algorithm for treating patients with multiple fractures of long bones at the stages of medical care was developed taking into account the characteristics of the injuries, the patient's condition, and the use of Damage-control tactics. Based on Bayes probability analysis algorithms, a mathematical model for estimating and predicting the results of rehabilitation and rehabilitation treatment of patients with multiple (gunshot and non-gunshot) fractures of long bones was developed. Improved devices of transport immobilization of limbs (by reinforcement of tires and use of elastic belts fixed between pneumatic chambers) provide optimal fixation of bone fragments with regulation of immobilization rigidity and control of the area of damage and viability of limbs (patent No. 110770 Ukraine). The technology (modern means of canning of wounds: sequence, regimes, frequency, intensity, efficiency criteria) of application of negative pressure therapy and ultrasonic cavitation in case of surgical treatment of gunshot wounds (patent No. 108899 Ukraine) was justified. The working classification of combat injuries of extremities taking into account the type of wounding projectile, the nature and type of injury, the number of affected systems, localization, joint damage, concomitant lesions, soft tissue and bone defects, degree of compartment syndrome and the presence of ischemic disorders have been developed. The system of telemedicine technologies was created, the criteria for its effectiveness were justified. The system for determining the incoming and outgoing assessment of patients' condition with the subsequent definition of the rehabilitation task and route and the formation of an individual program of medical rehabilitation was developed. The technology of replacement of defects of bone tissue with the use of combined bone-fibrin autoplasty (patent No. 105532 Ukraine) was developed. A comprehensive assessment of the functional results of treatment of victims with multiple fractures of long bones using the Matisa-Ljubovice-Schwarzberg scale and the SF-36 scale was developed. The results of the dissertation research were introduced into the clinical practice of the SI "Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine", the Military Medical Centers of the Western and Northern Regions, the National Military Medical Center "The Main Military Medical Hospital", the traumatology departments of the military unit A 2923, the Kiev City Clinical Hospital № 8 and № 4. Traumatology and Оrthopedics.
