An Easy-To-Use External Fixator for All Hostile Environments, from Space to War Medicine: Is It Meant for Everyone’s Hands?

Abstract

Long bone fractures in hostile environments pose unique challenges due to limited resources, restricted access to healthcare facilities, and absence of surgical expertise. While external fixation has shown promise, the availability of trained surgeons is limited, and the procedure may frighten unexperienced personnel. Therefore, an easy-to-use external fixator (EZExFix) that can be performed by nonsurgeon individuals could provide timely and life-saving treatment in hostile environments; however, its efficacy and accuracy remain to be demonstrated. This study tested the learning curve and surgical performance of nonsurgeon analog astronauts (n = 6) in managing tibial shaft fractures by the EZExFix during a simulated Mars inhabited mission, at the Mars Desert Research Station (Hanksville, UT, USA). The reduction was achievable in the different 3D axis, although rotational reductions were more challenging. Astronauts reached similar bone-to-bone contact compared to the surgical control, indicating potential for successful fracture healing. The learning curve was not significant within the limited timeframe of the study (N = 4 surgeries lasting <1 h), but the performance was similar to surgical control. The results of this study could have important implications for fracture treatment in challenging or hostile conditions on Earth, such as war or natural disaster zones, developing countries, or settings with limited resources.

Adequacy of in-mission training to treat tibial shaft fractures in mars analogue testing

“…Astronauts spent more time performing the second step to place correctly the EZExFix and to avoid skin compression, which is a main sub-criterion influencing good evolution. The longest step for both astronauts and surgical control was the fourth step, including fracture reduction and stabilization which is the second main sub-criterion 46 . Thus, astronauts automatically became aware of the paramount relevance of these two main criteria to rescue their patients, whereas surgeons only need to focus on the fourth step, probably because the second one is more easily acquired by their own experience.…”