Functional limb salvage in severe war injuries to limbs

High-velocity weapons usually result in a great amount of tissue damage and represent a surgical challenge. We analyzed the results of the treatment of patients after severe war injuries to the limbs (limbs at risk), in whom functional restoration of the limbs was performed. Eighteen patients with severe high-energy limb fractures after blast injuries and high-velocity gunshots were treated from 1993 to 2006. Soft-tissue debridement followed by axial realigning and fracture stabilization using tubular external fixators was performed on admission day in most of the patients. The primary tubular fixators were exchanged 5–7 days later for minimally invasive methods of definitive skeletal fixation (mostly Ilizarov frames), and soft-tissue coverage using delayed primary sutures, skin grafts or flaps was accomplished. Post-traumatic bone defects in three patients were treated by gradual bone transport in the Ilizarov frames. The injured limbs were preserved in all the treated patients and most returned to active lives. Staged treatment including primary temporary unilateral tubular stabilization performed in damage control procedures followed by definitive minimally invasive fracture fixation methods was found to be an effective tool in the management of patients suffering from severe tissue damage due to high-energy war injuries, including limbs at risk.