Combat-Related Orthopedic Trauma in the Russo-Ukrainian War: A Systematic Review

Clinical Snapshot

Key Findings

• Effect Size: Not applicable - descriptive review

• Primary Outcome: High-energy fractures, traumatic amputations, severe soft-tissue loss, and neurovascular damage from explosive and ballistic trauma

• Nnt Or Sensitivity: Not applicable - descriptive systematic review without quantitative synthesis

• Confidence Interval: Not reported

Clinical Application

Advanced surgical techniques described may require specialized training and resources not available in all settings Relevant for Australian Defence Force medical planning and civilian trauma preparedness; techniques may inform management of complex trauma in major trauma centres Limited direct applicability to routine civilian practice; most relevant for military medicine, trauma surgery, and disaster preparedness

Abstract

INTRODUCTION: The Russo-Ukrainian conflict has produced large numbers of military and civilian casualties, with orthopedic and musculoskeletal trauma representing a major proportion of combat injuries. Explosions, gunshots, and blast mechanisms frequently generate complex wounds that demand specialized surgical and rehabilitative management. This review summarizes injury types, mechanisms, severity, clinical responses, and gaps in current knowledge. METHODS: Following PRISMA guidelines, a comprehensive search of PubMed, Scopus, Web of Science, and MEDLINE via WoS was conducted in February 2025. Eligible studies published from 2014 to 2024 included case reports, case series, cohort studies, and observational research describing orthopedic injuries in military or civilian populations affected by the conflict. Two reviewers independently screened studies, performed quality assessments using Joanna Briggs Institute tools and STROBE criteria, and synthesized data qualitatively with descriptive statistics when available. RESULTS: Thirty-one studies were included, primarily case reports and retrospective analyses from Ukrainian military hospitals and frontline facilities. Explosive and ballistic trauma produced high-energy fractures, traumatic amputations, severe soft-tissue loss, and neurovascular damage. Management strategies included external and internal fixation, bone grafting, microsurgical reconstruction, distraction osteogenesis, and the progressive use of 3D-printed implants to support limb salvage. Rehabilitation, including pain control, physiotherapy, and prosthetic training, was essential for functional recovery. Long-term complications included neuromas, phantom pain, stump morbidity, and psychological trauma. Telemedicine enabled remote consultation and continuity of care under resource-limited conditions. CONCLUSIONS: Combat-related orthopedic injuries in this conflict require advanced surgical techniques, coordinated multidisciplinary support, and prolonged rehabilitation. Expanded data collection, standardized reporting, and long-term follow-up are essential to improve functional outcomes and reintegration.

References

1. 1.Garcia-Canas, R., & Navarro-Suay, R. (2026). Combat-Related Orthopedic Trauma in the Russo-Ukrainian War: A Systematic Review. Journal of Special Operations Medicine, 26(2). https://doi.org/10.55460/J.Spec.Oper.Med.2026.7V8D-PA9N