Page 24 - JSOM Spring 2026

Combat-Related Orthopedic Trauma in the Russo-Ukrainian War

A Systematic Review

Rafael Garcia-Cañas, MD, PhD *; Ricardo Navarro-Suay, MD, PhD 2
1

ABSTRACT
Introduction: The Russo-Ukrainian conflict has produced approximately 382,000 military casualties in 2025 and more
large numbers of military and civilian casualties, with ortho- than 1,168,000 cumulative casualties since the beginning of
pedic and musculoskeletal trauma representing a major pro- the full-scale invasion. Although precise Ukrainian military
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portion of combat injuries. Explosions, gunshots, and blast casualty figures are not publicly disclosed for security reasons,
mechanisms frequently generate complex wounds that demand international security analyses note that Ukraine continues to
specialized surgical and rehabilitative management. This re- experience significant losses consistent with the intensity and
view summarizes injury types, mechanisms, severity, clinical duration of large-scale conventional warfare. Civilian casu-
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responses, and gaps in current knowledge. Methods: Following alties documented by the United Nations exceed 30,000 con-
PRISMA guidelines, a comprehensive search of PubMed, Sco- firmed deaths and injuries, with actual numbers likely higher
pus, Web of Science, and MEDLINE via WoS was conducted due to incomplete reporting from frontline and occupied areas.
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in February 2025. Eligible studies published from 2014 to Humanitarian assessments further indicate that more than 14
2024 included case reports, case series, cohort studies, and ob- million people have been displaced internally or abroad since
servational research describing orthopedic injuries in military 2022, illustrating the extensive societal impact of the conflict
or civilian populations affected by the conflict. Two reviewers beyond direct battlefield casualties. Among the recorded inju-
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independently screened studies, performed quality assessments ries, orthopedic and musculoskeletal trauma constitute a major
using Joanna Briggs Institute tools and STROBE criteria, and proportion, consistent with long-standing evidence demon-
synthesized data qualitatively with descriptive statistics when strating that extremity trauma represents the leading source of
available. Results: Thirty-one studies were included, primarily long-term disability in modern armed conflicts. 5
case reports and retrospective analyses from Ukrainian military
hospitals and frontline facilities. Explosive and ballistic trauma Modern warfare is characterized by the extensive use of ex-
produced high-energy fractures, traumatic amputations, severe plosives, ballistic trauma, and high-energy transfer injuries,
soft-tissue loss, and neurovascular damage. Management strat- leading to increasingly complex musculoskeletal conditions
egies included external and internal fixation, bone grafting, that necessitate specialized medical expertise. Amputation re-
microsurgical reconstruction, distraction osteogenesis, and the mains one of the most prevalent consequences of severe mine-
progressive use of 3D-printed implants to support limb salvage. explosive injuries, which are often marked by extensive tissue
Rehabilitation, including pain control, physiotherapy, and pros- destruction and crushing. To optimize limb function follow-
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thetic training, was essential for functional recovery. Long-term ing such severe injuries, reconstructive and restorative surgical
complications included neuromas, phantom pain, stump mor- procedures are critical. While contemporary surgical tech-
bidity, and psychological trauma. Telemedicine enabled remote niques prioritize limb preservation, complications such as ex-
consultation and continuity of care under resource-limited tensive scarring, bone spurs, and soft-tissue abnormalities pose
conditions. Conclusions: Combat-related orthopedic injuries challenges to prosthetic fitting and functional rehabilitation. 7,8
in this conflict require advanced surgical techniques, coordi-
nated multidisciplinary support, and prolonged rehabilitation. Military conflicts have profound implications for orthopedic
Expanded data collection, standardized reporting, and long- surgery, as evidenced by the significant rise in cases requir-
term follow-up are essential to improve functional outcomes ing limb salvage procedures, complex fracture management,
and reintegration. and prolonged rehabilitation. 5,6,9,10 The management of war-
related orthopedic injuries in Ukraine places a considerable
Keywords: war-related injuries; Ukraine conflict; military strain on the healthcare system, necessitating the involvement
medicine; casualty; surgical management; combat trauma of both military and civilian medical institutions at tertiary
and quaternary levels. Consequently, there is a pressing need
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for innovative surgical techniques and enhanced rehabilitation
strategies to optimize patient outcomes. 11
Introduction
The Russo-Ukrainian conflict, ongoing since February 24, Orthopedic departments play a crucial role in providing both
2022, has resulted in substantial military and civilian casual- scheduled and emergency care for patients with musculoskeletal
ties. According to the UK Ministry of Defence, Russia sustained trauma. These departments function within multi disciplinary
*Correspondence to garciacanas@icloud.com
1 MAJ Rafael Garcia-Cañas is affiliated with the Orthopedic Unit and LT COL Ricardo Navarro-Suay is affiliated with the Anesthesia Unit,
2
Hospital Central de la Defensa Gómez Ulla, Madrid, Spain.
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