Andrii Dinets

Pelvic organ injuries in combat conditions are relatively uncommon but are associated with a high risk of complications, particularly urinary injuries combined with pelvic fractures, vascular trauma, and other abdominal injuries in the setting of polytrauma. The provision of effective medical care in modern conflicts is complicated by logistical constraints, including delayed evacuation, limited imaging capabilities, and shortages of specialized personnel. This study analyzes diagnosis, treatment, and complications of combat-related urinary injuries and identifies approaches to optimize medical care. A series of clinical cases was reviewed, including five patients treated at various stages of medical evacuation. Diagnostic strategies, surgical tactics, complications, and outcomes were evaluated. Challenges included delayed diagnosis, underestimation of injury severity, unjustified conservative management of intraperitoneal ruptures, technical shortcomings in bladder repair, and insufficient interdisciplinary coordination. Complications such as urinary extravasation, peritonitis, infection, and secondary fistula formation were observed. Favorable outcomes were associated with timely injury recognition, urgent surgical intervention, continuity of staged evacuation, and early involvement of urological expertise. Optimization of diagnostic and treatment pathways and strengthening multidisciplinary collaboration are essential to reduce morbidity in combat-related pelvic organ injury trauma.

The ballistic-associated and related to combat trauma osteomyelitis was and remained a clinical challenge for orthopedic war surgeons because of the variability of the infection course and frequent open fractures, including the Russia-Ukraine war. The aim of the study was to demonstrate approaches for management of femoral osteomyelitis associated with ballistic injury in combat settings, as well as to share clinical experience from military orthopedic surgeons obtained in the war in Ukraine. 19 male individuals were diagnosed with multifragmentary fractures of the femur complicated by osteomyelitis due to ballistic injury on the battlefield in Ukraine. The Cierny-Mader osteomyelitis classification was applied for the evaluation of the patients’ injuries. The orthopedic tactic for the femoral osteomyelitis included 4 stages to achieve the best treatment results. There were applied various approaches for the external bone fixation, such as temporary modular external fixation systems or Illizarov device, as well as monofocal, bifocal, and multifocal compression-distraction osteosynthesis. A significant bone defect > 7 cm associated with diffuse osteomyelitis was diagnosed in 5 (26%) patients. The bone resection was performed for these 5 patients, followed by multifocal osteosynthesis and distal osteotomy. 4 (21.1%) patients were diagnosed with cortical osteomyelitis intraoperatively, requiring removal of the sequestered bone tissue, followed by implantation of the antibiotic-loaded bone cement. As soon as the regression of the infectious process was confirmed, these 4 (21.1%) patients underwent bone alloplastic operation. 6 (31.5%) patients had a moderate bone defect up to 5 cm. These 6 (31.5%) patients underwent removal of the sequestered bone tissue along with bone resection and implantation of the antibiotic-loaded bone cement. In addition to adequate surgical debridement of the osteomyelitis, it is also important to administer an appropriate antibiotic therapy for the management of post-traumatic and ballistic-related osteomyelitis in patients with open fractures of the femur. Application of various modifications of compression-distraction osteosynthesis is one of the most appropriate methods in the complex surgical treatment of bone tissue defects resulting from segmental resection of osteomyelitis foci in the femur. The online version contains supplementary material available at 10.1186/s12245-026-01270-6.

The Russia-Ukraine war has produced widespread lethal ballistic trauma with unusual injury patterns, including rare cases of projectile migration and arterial embolism. Prompt differential management near frontlines is crucial to improve outcomes and reduce evacuation risk. The aim of the study was to present clinical features, diagnostic workup, and management of a combat patient with a penetrating chest wound, cardiac involvement, and subsequent migration of a ballistic fragment into the superior mesenteric artery (SMA), and to contextualize this case within existing literature on ballistic emboli. A 41-year-old serviceman sustained a chest injury from FPV-drone munitions. Initial delayed evacuation and staged imaging (X-ray, FAST, whole-body CT) identified a ballistic channel from chest to abdomen and a metallic intraluminal fragment in the SMA. Clinical decision-making weighed endovascular versus open approaches amid tactical constraints and patient consent dynamics. Contrast-enhanced CT suggested transcardiac migration of the fragment into the SMA. With absent critical mesenteric ischemia and delayed consent, laparotomy on day 14 revealed an intraluminal metallic fragment that was removed via arteriotomy with primary repair. The patient recovered and was discharged after 21 days. The arterial ballistic emboli must be suspected in patients with isolated chest- or thoracoabdominal injuries. The whole-body contrast-enhanced CT scan is an important diagnostic tool for patients with gunshot injuries. In the absence of evidence of bowel necrosis, surgery can be postponed in patients with SMA emboli. An important role in visualization is played by contrast-enhanced MSCT. We recommend removing projectile fragments from the major blood vessels.

The use of various types of weapons against the Armed Forces of Ukraine in the Russo-Ukrainian war leads to both typical and atypical clinical presentation

Background: Hypertensive disorders of pregnancy (HDP) are a major cause of illness and death for mothers and babies worldwide. Their number is rising due to older maternal age, obesity, and other health problems. Early diagnosis is important. Serum protein S100B, a calcium‐binding protein studied in brain diseases, is now being considered as a possible marker for predicting HDP. Methods: This narrative review looked at studies on S100B and HDP. A search was done in PubMed, Scopus, and Web of Science up to April 2025, with extra searches in Google Scholar. Sixty‐nine studies were included. We reviewed data on S100B structure, function, and its role in blood vessel injury, oxidative stress, and inflammation. Results: Studies show that S100B levels are higher in women with preeclampsia than in healthy pregnancies. Increased S100B is linked with blood vessel problems, oxidative stress, and damage to the blood–brain barrier. High levels are also related to more severe disease and neurological symptoms. Other studies found that S100B may help predict complications like preterm birth, growth restriction, and poor newborn outcomes. Experimental studies suggest that S100B acts through the RAGE pathway to worsen inflammation and vascular dysfunction. Conclusions: S100B protein has strong potential as a simple, non‐invasive biomarker for early detection and risk assessment in HDP. However, larger studies and standardized testing methods are needed before it can be used in clinics. Combining S100B with known markers such as PlGF and sFlt‐1 may improve accuracy in predicting pregnancy complications.