Content provided in partnership with

Health Care Industry

War Injuries of the Extremities: Twelve-Year Follow-Up Data

Military Medicine, Jan 2006 by Busic, Zeljko, Lovrc, Zvonimir, Amc, Enio, Busic, Vlatka, Et al

Background: More than 75% of all injuries in modern wars are injuries of the extremities, usually with highly contaminated wounds and major soft tissue destruction. In this review, we present the late functional results for 35 of 41 wounded patients who sustained solitary war injuries of the extremities with open fractures. Methods: During a 6-month period from August 1991 to February 1992, of a total of 1,050 injured patients, 49 wounded patients with isolated open fractures of the extremities were treated in General Hospital Nova Gradiska (Nova Gradiska, Croatia). The mean age was 34 years (range, 17-85 years); 44 wounded patients (90%) were male and 37 (76%) were soldiers. With primary amputations for 8 (16%) of 49 injured patients, external fixation was performed for 27 wounded patients (66%); primary internal fixation was applied for eight wounded patients (19.5%). After 12 years, 35 (85%) of the injured patients were available for evaluation concerning (a) fractured bone nonunion, (b) osteomyelitis, (c) late amputation, (d) nerve palsy, and (e) function, Results: Osteomyelitis occurred for five patients (12%), only one with primary external fixation. In two cases of delayed conversion of external fixation to internal fixation, osteomyelitis occurred, requiring external fixator restoration. This has been no recurrence of osteomyelitis in the past 5 years and, after 12 years, more than three-fourths of wounded patients showed no or mild reduction of function of related proximal and distal joints. According to Index of Independence in Activities of Daily Living scores, grade B was found for only two wounded patients, with grade A for the others. Conclusion: The application of external fixation is the first and definitive choice of treatment for war-related open fractures of extremities, producing good late functional results. Conversion of external fixation to internal fixation leads to osteomyelitis, demanding another operation and application of secondary external fixation.

Most Popular Articles in Health: Fuel your workout: exercisers who eat before they work out have more energy ...; Soothe a dry, itchy scalp: 5 easy expert solutions; Cocktails and calories: Beer, wine and liquor calories can really add up. ...; The sour truth about apple cider vinegar - evaluation of therapeutic use; The, six best supplements you've never heard of: these secret weapons can ...; More »

Introduction

More than 75% of all injuries in modern wars are injuries of the extremities.1-4 Two-thirds of injuries are caused by shell fragments, which cause open fractures in one-third of wound cases, usually with highly contaminated wounds and major soft tissue destruction.1,2,5-7 The use of external fixation in the management of such injuries is the method of choice, although, concerning the extent of soft tissue and bone damage, some authors dealing with open fractures suggest another approach.7-11

Such injuries are followed by a high risk of osteomyelitis attributable to many free and deperiosted bone fragments, as well as covering tissue defects and concomitant vascular injuries.1,4,5,7,8 The management of war-related open fractures of the extremities involves experience of the surgeon and requires patience of the wounded. Mangled extremities sometimes require primary amputations, in wartime based only on clinical assessment, which is not based on the Mangled Extremity Severity Score (MESS).12,13

Injuries caused by land mines usually lead to traumatic amputations of the foot or distal crural amputations.4,6,8,14,15 In our group of wounded, no injuries were caused by land mines, only shell fragments (mortars, grenades, and bombs) and bullets.

General Hospital Nova Gradiska was one of the war hospitals in the eastern part of Croatia in 1991-1993 and was near the battlefield lines; therefore, it received many wounded directly from the battlefield. In this review, we present the late functional results for 35 wounded patients who sustained solitary war injuries of the extremities with open fractures.

Methods

During the 6-month period from August 1991 to February 1992, 1,050 injured patients were treated in the General Hospital Nova Gradiska, of them 49 wounded patients with isolated open fractures of the extremities. With a mean age of 34 years (range, 17-85 years), 44 (90%) were male and 37 (76%) were soldiers. The cause of wounding was shell fragments for 21 (66%) of the injured patients, whereas 14 (34%) were wounded by bullets. The mean time of transportation from the site of wounding to the hospital was 58 ± 41.5 minutes (range, 15-210 minutes). Primary amputations were performed for eight (16%) of 49 injured patients (three femoral, two below-knee, two forearm, and one hand amputations); these patients were excluded from additional statistical analyses. Concomitant injuries were found as follows: three radial nerve, three ulnar nerve, one peroneal nerve, and two femoral superficial artery injuries. No primary nerve reconstructions were performed, whereas immediate femoral artery reconstruction was performed with vein grafts. For six wounded patients (12%), two extremities were injured.

Primary external fixation was performed for 27 (66%) of 41 wounded patients, i.e., humeral fixation for 8 (29%), forearm fixation for 4 (15%), femoral fixation for 6 (22%), and below-knee fixation for nine (33%). For eight wounded patients (16%), primary internal fixation was applied, i.e., plates with screws for six fractures (two humeral, two forearm, and two femoral fractures) and fixation with pins and wires for two patellar fractures (Table I). We used only unilateral external fixators with half pins.

Health Care Industry

War Injuries of the Extremities: Twelve-Year Follow-Up Data

Military Medicine, Jan 2006 by Busic, Zeljko, Lovrc, Zvonimir, Amc, Enio, Busic, Vlatka, Et al

Find Research Guides for:

Find Featured Titles for: Business

Most Popular Articles in Health

Most Popular Publications in Health