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Strengths and Limitations Author Contributions
We have multiple strengths, such as including studies that re- Both authors contributed equally to the conceptualization,
ported comprehensive multistage treatment approaches with design, literature search, data extraction, and analysis of
detailed stepwise management from emergency care to long- this study. RGC led the writing of the manuscript, including
term rehabilitation. Additionally, we reported a clear delinea- drafting and revising all sections, while RNS was primarily
tion of treatment phases (triage, initial stabilization, definitive responsible for supervision, critical review, and ensuring the
surgical interventions, and rehabilitation). We also reported methodological and scientific rigor of the work. Both authors
the application of modern wound management methods (VAC approved the final version and agree to be accountable for all
therapy, ultrasound cavitation, and pulsed lavage for infec- aspects of the research.
tion control). 5,30 Moreover, the limb salvage techniques using
Ilizarov fixation, bone grafting, and distraction osteogenesis Disclaimer
for bone reconstruction are the most important reported sur- The views expressed in this article are solely those of the authors
geries. We also reported new techniques such as 3D titanium and do not necessarily represent the official policies, positions,
implants and locked compression plates (LCP) for complex or endorsements of the Spanish Ministry of Defence, the Span-
shoulder arthrodesis. Studies covered a broad range of injury ish Armed Forces, or any affiliated institutions. All information
patterns, including gunshot fractures, mine blast injuries, limb is based on publicly available sources, and no classified or re-
amputations, and soft-tissue trauma, enhancing the generaliz- stricted data were used in the preparation of this manuscript.
ability of findings.
Disclosures
This review has several limitations. Notably, there was a lack The authors declare no competing interests related to this
of RCTs. Many included studies were retrospective and relied work. Neither author has financial, professional, or personal
on unclear or inconsistent data sources, which limited the over- relationships that could be perceived to influence the content
all quality of evidence. Furthermore, the predominance of case of this manuscript.
reports hindered comparative analysis and reduced the gener-
alizability of the findings. Most studies were observational or Funding
retrospective, limiting causality and generalizability. There is This research received no external funding. The authors con-
no direct comparison between different treatment methods to ducted the study independently and without financial sup-
determine the most effective approach. Variability in resources port from governmental, institutional, commercial, or private
and personnel between military and civilian hospitals may sources.
have influenced outcomes. Some studies had small patient co-
horts, making statistical conclusions less robust. Moreover, the References
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