Reconstructive surgery for gunshot injuries of the knee: experience from the Russo-Ukranian War 2022-2024

The invasion of Ukraine by the Russian Federation in February 2022 has witnessed the first peer-on-peer full-scale European conflict since World War 2. We have noted that the vast majority of injuries affect the extremities. Within that group, injuries to the joints pose a huge clinical challenge. Specifically, 17.1% of all gunshot injuries (GSWs) involved the joints, which represents 22.3% of all limb injuries. 55.6% of all GSW to the joints involved the knee; 10% had a concomitant vascular injury and 15%-20% had a nerve injury.The surgical management of ballistic knee injuries includes initial damage control surgery with debridement of non-vitalised tissue, vascular reconstruction and fasciotomies where necessary, with stabilisation of bone injury with a spanning external fixator. Following repatriation to Role 4 facilities, staged reconstruction is performed with cement spacers followed by autograft, endoprosthesis or arthrodesis. Where reconstruction is not possible, above-knee amputation remains an option.In this paper, based on the analysis of 33 cases, we describe the Ukrainian early experience of the management of gunshot wounds to the knee joint with three clinical case studies as representative examples.