On 18 June 2026, a scheduled scientific and practical conference entitled “TREATMENT OF LIMB FRACTURES USING EXTERNAL FIXATION DEVICES” was held at the Municipal Non-Profit Enterprise “M.I. Kononenko Chuhuiv Central District Hospital” in a hybrid format, both offline and online, with approximately 100 participants attending. The conference, organised as part of the “Traumatologist’s Day” by the Kharkiv Regional Branch of the Ukrainian Association of Orthopaedic Surgeons and Traumatologists and the Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, took place on the third floor of the hospital’s outpatient building.

The conference was opened by the Chairman of the Kharkiv Regional Branch of the Ukrainian Association of Orthopaedic Surgeons and Traumatologists, Professor Volodymyr Filipenko, who highlighted the continuation of the tradition of annual meetings of trauma specialists from the Kharkiv region outside the city of Kharkiv. He noted that the last meeting of the Association held at Chuhuiv Hospital had taken place in 2015. He expressed satisfaction that the hospital in Chuhuiv continues to operate and was able to host the planned conference.

The participants were then welcomed by the Director of the hospital, Honoured Doctor of Ukraine Viacheslav Hrushka, who presented and commented on a documentary film about the work of the Municipal Non-Profit Enterprise “M.I. Kononenko Chuhuiv Central District Hospital” from 05:00 on the first day of the full-scale invasion in February 2022. At that time, the hospital had a capacity of 320 beds, including 240 designated for COVID-19 patients. Since 2014, the hospital had been preparing for wartime conditions by establishing seven emergency teams and conducting training for surgeons and trauma specialists. However, the realities of war presented unprecedented challenges, with 38 to 68 patients arriving simultaneously. Despite shortages of medicines, external fixation devices, operating theatres, and constant shelling, the medical staff who remained at the hospital and lived on-site continued to provide medical care to the wounded, sometimes performing surgical procedures on the floor. The documentary demonstrated the extensive destruction of the hospital buildings and the subsequent restoration efforts, including the replacement of more than 1,000 windows and 800 doors. Surgical and trauma services continued uninterrupted, working closely with military surgeons and Professor Oleksii Popsuishapka. The hospital also independently established an underground operating facility. The Director expressed his gratitude to everyone involved in supporting the hospital and to all participants who travelled to Chuhuiv for the conference.

In the opening presentation, entitled “External Fixation Devices: Their Functional Properties and Associated Features of Bone Regeneration. Principles of Constructing the ‘Bone Fragments–Fixator’ System in Fracture Treatment”, Professor Oleksii Popsuishapka of Kharkiv National Medical University presented his extensive experience in treating limb fractures using external fixation devices (EFDs). He reviewed Ukrainian-manufactured systems by NV Orto, currently the most widely used devices developed in response to wartime needs, as well as internationally manufactured systems by Stryker, Orthofix, and Biomet, together with devices of his own design, certified for production since 2013. The presentation covered the materials used in device construction, clamps, design characteristics, pins as the key structural element, common insertion errors, principles of bone thread formation, the resiliently stable connection between bone fragments, biomechanical research findings, factors initiating bone regeneration, and the three fundamental principles of fracture management using external fixation. Particular attention was given to differences between international practice, where external fixation is primarily used as temporary damage control before conversion to internal osteosynthesis following wound healing (according to AO Surgery Reference guidelines), and the treatment philosophy traditionally adopted in Ukraine. The speaker also discussed the principles of minimising transverse pin leverage and achieving biplanar pin insertion.

The relevance of the topic “Treatment of Limb Fractures Using External Fixation Devices” has increased dramatically during the war. In his presentation, PhD Vitalii Veklich shared the experience of Ladisten Clinic in Kyiv, where both children and adults with orthopaedic and trauma conditions are treated. Reviewing the history of osteosynthesis, he demonstrated that modern fracture treatment methods often fail to provide the optimal combination of mechanical and biological factors required to maximise regenerative capacity. He presented numerous clinical cases illustrating the successful use of the Ilizarov external fixation system in adults and children, supported by video demonstrations. A particularly remarkable case involved a patient with bilateral humeral blast injuries resulting in approximately 7 cm bone defects in both humeri, successfully treated by simultaneous bifocal external fixation with defect reconstruction. The speaker noted that he has been working in this field for approximately 47 years, during which the technique has undergone continuous refinement. More than 6,000 patients have been treated using these methods, including during his work at the Kyiv Institute of Orthopaedics and Traumatology.

In his presentation, DMSc Valerii Lytvyshko, Orthopaedic Trauma Surgeon at the Municipal Non-Profit Enterprise “M.I. Kononenko Chuhuiv Central District Hospital”, presented the experience of treating 462 patients with diaphyseal limb fractures managed using external fixation. Of these, 325 patients were treated at Chuhuiv Central District Hospital and 137 at the Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine. Patients were divided into three groups: non-gunshot fractures, non-union fractures, and gunshot fractures. The presentation demonstrated resiliently stable fixation devices consisting of ebonite or fibreglass support bars combined with conically threaded pins, three types of resiliently tensioned fixation systems allowing controlled fragment repositioning in one or multiple planes, as well as NV Orto and French external fixation systems used in the treatment of severe combat-related fractures. Numerous illustrative clinical cases were presented.

The presentation by PhD Yurii Klapchuk and co-authors, entitled “Anatomical and Functional Considerations in the Assembly of Pin-Based External Fixation Devices for Combat Injuries of the Upper Limb”, focused on the role of external fixation as the preferred damage control method, allowing rapid stabilisation, infection control, and excellent wound access. The speakers described the systems currently used in treating military casualties admitted approximately three days after injury. The presentation covered the basic components of pin-based fixation systems, principles of application, safe anatomical corridors for pin insertion in the upper limb, advantages and disadvantages of antibiotic-loaded cement spacers, clinical aspects of applying external fixation to different anatomical regions, as well as common technical errors and complications. Particular emphasis was placed on timely removal of external fixation devices and conversion to definitive fixation when clinically indicated.

Professor Valentyn Piontkovskyi presented a lecture entitled “Acetabular Injuries: Diagnosis and Surgical Strategy”. He began by emphasising the fundamental distinction between acetabular fractures and pelvic fractures, noting that one primarily threatens hip joint function whereas the other may threaten the patient’s life. Four principal mechanisms of acetabular injury were reviewed: axial impact through the flexed knee, axial impact through the extended knee, lateral impact to the greater trochanter, and impact through the sacroiliac joint or anteroposterior pelvic compression. The speaker explained how the position and rotation of the femur at the moment of injury determine fracture configuration. He reviewed the Letournel classification, illustrated its clinical application, highlighted the importance of preoperative computed tomography, discussed indications for conservative treatment, skeletal traction, external fixation, surgical approaches, reduction techniques, spring plate osteosynthesis, and presented numerous clinical examples.

In his presentation entitled “Bone Transport as an Effective Method for Reconstruction of Bone Defects Following Combat Trauma”, PhD Oleksii Marushchak discussed the principles of bone transport for the management of extensive femoral and tibial bone defects, allowing reliable restoration of skeletal continuity and limb function while frequently preventing amputation. He noted that bone transport has become particularly important since the beginning of the war. Although the technique itself is well established, modern developments include the Masquelet technique, vascularised and non-vascularised bone grafting, and the use of cages with osteoplastic materials. The speaker reviewed several international publications, including Y. Liu et al., “Complications of Bone Transport Technique Using the Ilizarov Method in the Lower Extremity: A Retrospective Analysis of 282 Consecutive Cases Over 10 Years” (2020), and N. Mohd-Yusof et al., “Clinical and Functional Outcomes of Ilizarov Bone Transport in Traumatic Tibial Bone Loss” (2025). He also shared his own experience, discussing difficult clinical decisions, complications, lessons learned, successful outcomes, and presented several clinical cases demonstrating favourable treatment results using bone transport.

Stanislav Hubskyi, a physician of the Department of Emergency Traumatology and Reconstructive Surgery at the Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, delivered a presentation entitled “Application of Pin-Based External Fixation Devices for Primary Stabilisation of Fragments in Gunshot Injuries of the Limbs”. He discussed the advantages and limitations of external fixation devices and recommended the publication by C. Giannou, M. Baldan, and A. Molde, War Surgery: Working with Limited Resources in Armed Conflict and Other Situations of Violence (2021). His presentation covered preoperative planning, multidisciplinary involvement of vascular and plastic surgeons when required, surgical techniques for applying external fixation to different limbs while considering anatomical features, options for frame configuration, selection of pin dimensions, and included several clinical cases involving military personnel treated in the department.