According to the literature data, the article considers the occurrence and development of acute and chronic osteomyelitis. The basic principles of classification and terminology are presented. The authors paid special attention to the features of the clinical manifestations of osteomyelitis and its spread, identified clinically important focal changes in osteomyelitis. The etiology, pathogenesis and features of pathophysiology with a different mechanism for the development of osteomyelitis are considered. The moments, affecting the formation of orthopedic outcomes in the form of deformations, shortening of limbs are noted. The authors examined the complications and tactical features in the treatment of the effects of osteomyelitis. The importance of a systematic approach to treatment, the determination of the stages and their contents, taking into account the main process and the anatomical and functional expediency, are accentuated.
The paper presents a case of severe gunshot wound of the shin in a 16-year-old adolescent as a result of gunshot from a small distance. Comminuted fracture of the tibia, damage of the anterior tibial artery, defect of the soft tissue in the injured area were detected. When admitted to the hospital, the patient underwent surgical treatment of the wound and fixation of fragments in carboxylic rod apparatus of external transosseous fixation. Osteomyelitis was developed. Ten days later, reosteosynthesis was performed. The first stage of bilocal osteosynthesis of the right shin was implemented, necrotized soft tissues and bone fragments and detritus were removed, initial purulent process was arrested. There was started distraction of the distal fragment of the tibia obtained as a result of its corticotomy in the lower third into the bone defect measuring 5 cm, which occurred when implementing surgical treatment of the wound. Twenty-eight days after, open alignment of tibial fragments in the upper third and reinstallation of Ilizarov apparatus was performed. The site of fragment junction was closed with unfree skin flap on the pedicle measuring 4 6 cm, the transplant bed was closed with full-layer skin graft using Parins technique. The further consolidation of fragments was reached simultaneously with maturation of the bone regenerate. The total period of fixation in Ilizarov apparatus lasted for 8 months. The bone and soft tissue structural integrity was restored, full function of the lower limb and adjacent joints was reached. Ilizarov apparatus is indispensable in multistage treatment of gunshot fractures and provides dynamic correction in changeable conditions; it permits to preserve the limb and its functionality.
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