Severe injuries to the limbs

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Modern weapons and high-energy accidents cause significant damage to soft tissue and bone, necessitating immediate external fixation and thorough debridement due to contamination. The subsequent treatment phase involves covering exposed bone with vital soft tissue and achieving definitive skeletal stabilization, which poses complex surgical challenges. The authors present a protocol for staged external fixation, beginning with primary temporary unilateral tubular stabilization, followed by definitive circular Ilizarov (hybrid) fixation. This comprehensive guide serves both young and senior orthopedic trauma surgeons in the staged reconstruction of limb function. It details the rationale and advantages of a logical progression of surgical steps, supported by an extensive collection of clinical photographs and X-ray documentation illustrating each treatment phase across various complex cases, including significant bone and soft tissue loss. Drawing on 40 years of experience in managing severe musculoskeletal injuries, particularly war-related trauma, the text emphasizes the importance of soft tissue care, sequential damage control, and the strategic use of external fixation.