Background. The degree of adaptation of the body depends on many factors, including its ability to adapt to certain factors that cause damage. After all, it is soldiers who are constantly exposed to physical and metabolic stress. Purpose: to perform a clinical assessment of the adaptation of the body in military personnel with shoulder injuries based on leukocyte index, blood biochemical indicators, and hemostasis system markers. Materials and methods. A survey of 34 military personnel was conducted, all of whom were male patients diagnosed with shoulder injuries. The average age of patients was 47.52 ± 12.25 years. All of them were divided into 4 groups according to the leukocyte index: group I — patients who showed a stress reaction (n = 5); group II — patients with a training reaction (n = 8); group III — patients who showed a calm activation reaction (n = 12); group IV — patients with an increased activation (n = 9). Stress was assessed according to the Mississippi scale, pain — according to the visual analogue scale. The following were examined in the patients’ blood: leukocytes — by counting in a Goryaev chamber, leukogram — in smears stained according to Romanowsky-Giemsa, erythrocyte sedimentation rate — by the Westergren method. The following biochemical markers were determined in blood serum: total protein — using the biuret method, glucose — using the enzymatic method, and a thymol test was performed. The content of fibrinogen, active partial thromboplastin time (APTT), prothrombin time (PT) and soluble fibrin-monomer complexes in blood plasma was determined using ready-made reagent Renam kits. Results. The most pronounced changes in the integral leukogram indicators, markers of coagulation, and liver enzyme activity were observed in patients with a stress response; less pronounced disturbances were detected in patients with a training response. The indicators for calm adaptation and increased activation reactions were the least altered, which is associated with compensatory mechanisms in the patients’ bodies. The most diagnostically significant in the study groups of patients with varying degrees of adaptation were leukocyte index of intoxication, fibrinogen level, APTT and PT, and in patients with acute stress reaction — alanine aminotransferase, aspartate aminotransferase and glucose activity. Conclusions. The laboratory results help us figure out what stage of stress response the patient is at and check out their ability to adapt based on the clinical assessment of biochemical tests and hemostasis markers.

Background. Full-scale military operations are accompanied by an increase in the number of wounded with severe limb injuries, often requiring amputation. Despite advances in surgical technology, a significant proportion of patients develop pathologically altered stumps after lower limb amputation, complicating prosthetics and further rehabilitation. Aim: to improve the effectiveness of reconstructive and restorative treatment of patients with lower limb amputation stump defects after combat trauma by improving amputation plastic surgery techniques. Materials and methods. Clinical examination and surgical treatment were performed on 126 patients with lower limb amputation stump defects, among which post-traumatic lesions caused by mine-blast and gunshot wounds prevailed. A total of 137 reconstructive surgical procedures were performed, including myoplastic, osteoplastic, and skin-subcutaneous operations. Radiographic, ultrasonic, and histological methods were used to evaluate the outcomes. The duration of follow-up ranged from 3 months to 5 years. Results. All patients achieved stable positive results with the formation of an elastic, painless and functionally complete stump suitable for modern prosthetics. The use of developed and improved methods of skin, muscle and bone plastic surgery contributed to an increase in stump stability, uniform load distribution in the prosthesis socket and a reduction in the percentage of defective stumps. Conclusions. Closure of defects with skin and subcutaneous flaps is the method of choice for reconstructing amputation stumps of the lower leg after combat injuries. Fixing muscles to the bone allows you to eliminate stump defects and obtain an elastic muscle stump. The formation of interosseous synostosis using various osteoplastic methods significantly improves the functional properties of the stump and contributes to effective prosthetics.

Background Falls from height are associated with significant traumatic injuries and poor outcomes. Improving our understanding of patterns associated with this patient group enables clinicians to improve their patient management in the prehospital and hospital environment. Objectives To describe the injury patterns and clinical outcomes of patients presenting to the Emergency Department at University Hospitals Southampton after falling from the Itchen Bridge, Southampton. Methods We conducted a retrospective cohort study of thirty patients who attended University Hospital Southampton following a fall from the Itchen Bridge between 2011 and 2023. Twenty-six patients who fell into water from heights of approximately 20-30m were included in the primary analysis. Clinical data were then extracted from medical records. Results Hypothermia was the most common presentation (n = 23), followed by pneumothoraces (n = 14), rib fractures (n = 10), thoracic vertebral fractures (n = 9) and lung contusions (n = 8). Lower water temperatures at the time of the incident (p = 0.008) and lower patient body temperatures on arrival to hospital (p = 0.002) were significantly associated with increased 30-day mortality. Conclusion Falls from heights of 20-30 m into water frequently results in hypothermia and intrathoracic injuries. Prehospital clinicians attending falls into water from similar heights should recognise the importance of early rewarming to treat hypothermia and be suspicious of intrathoracic injuries.

Background Selective conservative management of asymptomatic patients with small pneumothorax (PTX) in the specific setting of thoracic stab wounds (SWs) remains controversial. Methods A prospective study was conducted over a 15-year period on patients with isolated thoracic SWs with small PTX on chest radiograph (CXR) (< 2 cm) and who were asymptomatic. These patients did not undergo tube thoracostomy (TT) but rather active clinical observation at a major trauma centre in South Africa. Results Two hundred and eighty-four patients were included (91% male, mean age: 24 yrs). Eight (3%) eventually required TT: three deteriorated clinically and five demonstrated radiological progression of PTX on interval CXR. Of these eight patients who required TT, six (75%) had multiple SWs. All eight patients had uneventful recovery. All other patients who were managed successfully with clinical observation alone were discharged home. No patients represented to the hospital following discharge. There was no morbidity or mortality as a direct result of our selective conservative management approach. Conclusion Selective conservative management of patients with asymptomatic small PTX < 2 cm following thoracic SWs appeared to be safe. The vast majority of these patients do not require TT. Active clinical observation alone by an experienced clinician is sufficient.

Background. The purpose of this study was to evaluate the characteristics of the postoperative period in military personnel with non-combat injuries of the intra-articular structures of the knee joint. Materials and methods. A total of 52 arthroscopic procedures were analyzed in 21 military personnel (group A) and 31 civilians (group B). Functional outcomes were assessed using the Knee Society Score, visual analogue scale, Lovett muscle test, and goniometry. Military personnel demonstrated more severe cartilage lesions (Outerbridge grade 3–4), poorer Knee Society Score outcomes in older age groups, and fewer “excellent” results compared to civilians. Results. Both groups showed significant postoperative improvement, particularly in pain reduction and range of motion recovery. Conclusions. These findings highlight the need for broader rehabilitation strategies and the use of regenerative technologies in the military population to optimize functional recovery of the knee joint.

Background. The formation of symptomatic stump neuromas is one of the most common complications after amputation. Symptomatic neuromas cause pain, which, in turn, reduces the quality of life and makes prothesis use complicated or even impossible. Neuroma development is a result of disorganized axonal growth due to the lack of a target for reinnervation. After transtibial amputation, neuromas most often growth from the superficial peroneal nerve (SPN), due to its anatomical location and function. The purpose was to substantiate and describe the novel surgical technique for prevention of SPN neuroma formation by creation a physiological target for reinnervation in the form of a vascularized denervated muscle target (VDMT) derived from the anterior tibial muscle during transtibial amputation. Materials and methods. The technique involves isolation of a vascularized denervated segment from the tibialis anterior muscle, taken from below the level of the planned transtibial amputation, further mobilization of the flap on the anterior tibial vessels, followed by proximal rotation and wrapping of transected SPN. Results. This technique creates a target for organized axonal regeneration of SPN and prevents symptomatic neuromas development. Our own clinical experience with this technique indicates a slight increase in the duration of the surgical intervention and the absence of specific complications. The proposed method allows for targeted prevention of the formation of symptomatic neuromas during transtibial amputation, especially for high-risk nerves, such as the SPN. Conclusions. The tibialis anterior VDMT flip flap technique during transtibial amputation is a promising method for preventing symptomatic superficial peroneal neuromas. If necessary, this method can be applied to other or multiple nerves. Further clinical studies are needed to evaluate long-term results.

Introduction Adequate analgesia is an essential element of patient care. A recent investigation into a UK major incident (MI) highlighted that delivery of analgesia during it was inadequate. A subsequent inquiry suggested that oral transmucosal fentanyl citrate (OTFC) may improve delivery of analgesia in this setting. This systematic review aims to determine the most effective and safest dose of OTFC in the context of a MI for adults, children, the frail and elderly, and the hypovolaemic. Methods A literature search of MEDLINE, CINAHL, and Embase was conducted, searching for articles containing original data in human subjects with no restriction for language. Hand-searching of all articles was also undertaken. Data from included papers were extracted into a template and risk of bias assessment completed using the Cochrane RoB2 tool. A random effects model was planned for meta-analysis. Results 28 papers were included. 13 reported adult data (1227 individuals), one reported on the frail and elderly (five individuals) and 14 reported on children (593 individuals). 18 of the papers were randomised controlled trials; the remainder were observational studies. The heterogeneity of papers precluded meta-analysis. In adults, a dose of 800mcg provided the best balance between effectiveness and safety. For children, 10–15mcg/kg had a similar profile. Effectiveness was good, with most patients showing a clinically significant reduction in pain. Serious adverse events were rare, although minor side effects were more prevalent. Discussion The lack of evidence originating from MIs and in some groups of interest is the greatest limitation of this study. However, we are confident to recommend that in adults 18–65 years of age, who are responsive to voice, 800mcg of OTFC would provide safe and effective analgesia. In children >5 years of age, who are responsive to voice, 10–15mcg/kg of OTFC will provide safe and effective analgesia.

Background. Fractures of the tibia remain one of the most common and at the same time most complex injuries of the musculoskeletal system. Their treatment is often complicated by significant soft tissue damage, open wounds, instability of fragments, and the risk of infectious complications. In such cases, external fixation methods are an important stabilizing tool that allows control over the position of fragments with minimal invasiveness. Among the main methods for external fixation in the treatment of tibial fractures, the classic Ilizarov apparatus and modern hexapod systems, such as the Taylor spatial frame (TSF), are most widely used. The purpose was to conduct a systematic comparison of the efficacy and safety of the Ilizarov method and the TSF in the treatment of tibial fractures, taking into account the time of fracture consolidation, the frequency of complications, the time of union, and the degree of deformity correction. Materials and methods. The search was conducted in the PubMed, Semantic Scholar, and Scopus databases from 2014 to 2025. A total of 105 studies were identified in all databases. All included studies had a retrospective cohort design. No randomized controlled trials meeting the PICO criteria were found. Results. The total number of observations was 723 patients (338 individuals using the Ilizarov method, 385 using the Taylor method). There was no evidence of a significant difference in the number of open and closed fractures. Despite the high heterogeneity (I2 = 92 %) of the studies, no significant difference was found between the systems in terms of fracture consolidation times. Healing times varied greatly depending on the location of the fracture, its complexity, and the initial condition. The Ilizarov group had a slightly higher, but not significant, fixation index. The difference in the risk of infection between the methods is not statistically significant. The magnitude of residual deformity was reported in two studies. The angle of residual deformity of the tibia in the Ilizarov group was 0.7° greater than in the TSF group, the difference is statistically significant. Conclusions. According to the meta-analysis, when comparing the efficacy and safety of the Ilizarov method and the TSF in the treatment of tibial fractures, no statistically significant differences were found between these systems in terms of fracture healing time or the number of complications. At the same time, the Taylor frame showed significantly better results in terms of final limb deformity. It should be noted that the accumulated clinical experience and improvement of recommendations for the use of both fixation methods, depending on the type, location, and complexity of the fracture, have almost eliminated the differences in the frequency of complications. It should be noted that although some authors provided data on the types and complexity of tibial fractures, the summary results were published without specific reference to these characteristics. Therefore, it is impossible to draw definitive conclusions about the superiority of one system or another in individual clinical cases. Given the significant variability of fractures, the effectiveness and safety of treatment methods can only be reliably determined if a sufficiently large amount of clinical data is available.

Background. Fractures of the distal epimetaphysis of the humerus account for 16 to 50 % of all bone fractures and 50–80 % of all intra-articular injuries of the upper limb in pediatric practice. Among the injuries of this location, supracondylar (3–18 %) and transcondylar fractures (57.5–70 %) predominate, mainly in children aged 4 to 9 years. The epidemiology of supracondylar fracture types according to the Gartland classification is as follows: I — 36.7 %; II — 26.2 %; III — 30.9 %; IV — 6.3 %. In the global orthopedic and traumatology practice, a certain consensus has been reached regarding the treatment of supracondylar fractures type I (external immobilization), type III–IV (closed/open reduction, internal fixation, external immobilization), but regarding type II, the question is actively discussed: is internal fixation necessary after closed reduction? The purpose was to determine the current treatment for Gartland II supracondylar fractures of the humerus in children and adolescents. Material and methods. The research methodology is based on the recommendations of the Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. The search for literature sources was carried out using modern domestic and foreign databases, the depth of the search was the last 5–7 years using the follo­wing terms: distal humerus, supracondylar fractures Gartland II, pediatric patients, treatment. Results. According to the results of the analysis of literary sources, there is no consensus on the treatment of Gartland II fractures. Some authors characterize the surgical method of treatment as traditional; others claim the high effectiveness of conservative treatment based on their own clinical material. The point of view on the feasibility and effectiveness of both methods is significant. The authors justify the relevance of improving and objectifying the indications for their use, which will allow for the development of a coordinated treatment stra­tegy. Conclusions. Supracondylar fractures of the humerus in pediatric practice account for 3–18 %, mainly in children aged 4 to 9 years. In the global orthopedic and traumatology practice, the issue of treating Gartland II fractures, which occur in 26.2 % of cases, is actively discussed. A pressing issue today is the identification of risk factors that lead to complications, and indications for the use of a particular method, which requires further study.

Background. One of the problems in revision hip arthroplasty is the removal of the stable femoral component. The use of a cerclage wire for fixing the bone flap after osteotomy raises several unresolved issues: the choice of the optimal number of the osteotomized flap fixation levels, the number of cerclage wire turns, and the degree of postoperative load on the operated lower limb. The purpose was to conduct a comparative analysis of the stress values in the femoral model with a revision stem after extended proximal osteotomy (ETO) depending on the options for fixing the bone flap with a cerclage wire. Materials and methods. A basic finite element model of the femur with a revision endoprosthesis was created. It contained femur, revision endoprosthesis, and bone flap. Three options for fixing the bone flap at one, two, and three levels were modeled. Two turns of a cerclage wire with a diameter of 1.5 mm were applied at each level. The model was loaded with a distributed force of 1100 N. Results. When fixing the bone flap at one level, the maximum stresses in the femur are determined at the distal part of its diaphysis — 48.1 and 43.9 MPa, respectively, from the medial and lateral sides. The minimum stress level of 8.7 MPa was revealed in the bone flap, which is explained by the presence of interfragmentary regenerate between it and the femur, which performs a damping function. Stresses in the endoprosthesis tend to increase from 158.8 MPa in the neck to 213.4 MPa at the proximal end of the stem. The maximum stress level of 834.1 MPa is observed in a cerclage wire, which is 1.6 times higher than the tensile strength of surgical steel and can cause wire breakage. Fixation of the bone flap with a cerclage wire at two levels leads to a decrease in stress values at all control points on the femur. A decrease in stress values by 2 times was determined in a cerclage wire, which is associated with the redistribution of loads to two fixation points. The wire winding at the third level practically didn’t influence the stress distribution in the bone elements of the model. Conclusions. Fixation of the bone flap at two and three levels does not significantly affect stresses in the femur but allows you to halve the magnitude of stress in the wire itself, which with a single-level fixation can exceed the tensile strength of surgical steel. In the absence of technical possibilities to perform fixation at several levels, a single-level fixation can be applied under the conditions of using a wire winding of at least 4 turns and a load on the operated limb of no more than 50 %. The optimal option for fixing the bone flap is a two-level cerclage fixation, which provides a reduction in stresses in the wire below the tensile strength of surgical steel. Although a three-level fixation provides an even greater reduction in stresses in the wire to 326.2 MPa, the difference compared to a two-level fixation is not so significant as to justify additional tissue trauma and extending the operation time. Limiting the load on the operated limb to 50 % allows reducing the tension in a cerclage wire below critical values even with a single-level fixation, which can be recommended for the early postoperative period until a sufficiently strong interfragmentary regenerate is formed.