This article is based on the analysis of surgical treatment peculiarities of 641 patients with post-osteomyelitis long bones defects. The average age of patients at the time of hospital admission was 32,4 ± 0,7 and ranged from 4 to 70 years. Most of them were people of active working age (476 (74.3%)) and male (523 (81.1%)).

In this observation group 566 (88.3%) patients had the osteomyelitis process of the traumatic origin, including post-surgical (n = 155) and post-gunshot injuries (n = 13). Chronic hematogenous osteomyelitis was diagnosed in 75 (11.7%) patients. Most patients had lower extremity bones problems, including 444 tibia defects and 142 femoral bone defects. Much fewer patients had the osteomyelitis process of the upper extremity (humerus, radius, ulnar bone – 18, 19 and 18 respectively).

Purulent necrotic process was accompanied by nonunion bone fragments in 160 (24%) patients, delayed union in 95 (14.6%) patients, false joint in 178 (27.6%) patients, segmental bone defect in 75 (11 5%) patients and bones union with edge defects and cavities in 143 (22.3%) patients.

340 (53%) patients were operated using the method of free bone grafting, and 301 (47%) patients were operated using the distraction method.

The need to use the bilocal for external fixation on upper extremities occurs quite seldom (twice in our observations). Even when there is an upper extremity bone defect of several centimeters the preference should be given not to bilocal external fixation.

When treating the lower extremities taking the above mentioned into consideration, segmental defects predominated, that is why the bilocal distraction-compression method of surgical treatment prevailed (98.6%).

Thus, the main method of upper extremities long bones defects replacement is free bone grafting with segment fixation by the external fixation device, for lower extremities the is not-free main Ilizarov method, which allows to get positive results in 84.6% of patients with femoral bone problems and in 96.4% of tibia problems, mainly due to one-step treatment, directed simultaneously to inflammatory process elimination and maximum possible anatomical and functional restoration of the affected extremity.

Despite the increase of surgical procedures for extremities injuries and improvement of various fixation devices and surgical methods, the number of unsatisfactory osteosynthesis results reaches 2–7%. Chronic osteomyelitis after lower extremities long bones osteosynthesis occurs in 1.3–23% of cases, and the percentage of bone nonunion due to infections reaches 83%.

We conducted a retrospective analysis of 237 patient treatment with chronic osteomyelitis following tibial and femoral bone osteosynthesis. Two groups were selected for the analysis: the first group contained 194 patients treated with sheets and the second one contained 43 patients treated with intramedullary locked nails.

In cases of unconsolidated fractures and false joints, the necrectomy was performed with single-step or two-step replacement of internal fixation for external fixation. In this case segmental bone defects reached 20.9% in the first group and 3.6% in the second one. Here the treatment was performed using the Ilizarov method with the bone defect distraction replacement.

Conclusions. 1. Chronic osteomyelitis following sheets usage, unlike the osteomyelitis following the intramedullary locked osteosynthesis, leads more often to the formation of edge and segmental bone defects, which significantly prolongs the treatment duration.

2. External fixation application for postoperative osteomyelitis treatment in case of the bone nonunion made it possible to eliminate the purulent process and restore the extremity support function.

3. The inflammatory process relapses reached 14.9% in the first group and 3.1% in the second one.

Our work is based on the analysis of 104 patients with suppurative posttraumatic osteoarthritis of the ankle joint.

By prolonged septic arthritis with degradation of articular surfaces of ankle and shin bones we used necrectomia with osteoarthrotomy and compression arthrodesis in the mechanism of external fixation, which allows to radically sanify the nidus of infection and eliminate the inflammatory process all together. This operation was performed for 68 patients.

Surgical treatment for 18 patients with septic arthritis of the ankle joint with considerable involvement of ankle joint metaepiphysis was performed in the following way. We performed segmental resection of the shin bone distal part, put in external fixation mechanism with the possibility of defect building, and then we performed the osteotomy of the shin bone in its upper one-third. On the 10th day we started performing building of defect by Ilizarov.

For six patients with ankle joint septic arthritis with considerable involvement of ankle bone we performed its subtotal resection and compression arthrodesis in the external fixation mechanism. For patients with total overall affection of the ankle bone we performed ankle bone excision and tibialcalcaneal fusion. For three patients we performed ankle bone excision with tibialcalcaneal fusion and external fixation. For nine patients where it was not possible to perform a single-stage fusion of shin and heel bones we used external fixation mechanism with the possibility to move the shin bone fragment. Then we performed open fusion of shin and heel bones.

The result was considered to be position (92% of patients) in case of extremity support ability recovery, suppurative process elimination and bony ankylosis achievement.

Original ankle joint injury nature and localization are very important in selecting the necessary surgical treatment variant.

Differential surgical treatment tactics selection for patients with suppurative ankle joint osteoarthritis together with adequate usage of conservative therapy allow to eliminate active purulo-necrotic process and restore the extremity support function for most patients.