External Fixation in War Trauma Management of the Extremities—experience From the War in Croatia

Huljev, Dubravko; Rašić, Žarko; Trajbar, Tomislav; Kośuta, D; Vjenceslav, Nadinic

doi:10.1097/00005373-199411000-00021

Cited by 18 publications

(9 citation statements)

References 0 publications

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“…Pin tract infection rates were high and this has also been previously reported in the military environment (11). This has been postulated as a potential problem and may be related to the extensive contamination that occurs with ballistic injuries (15).…”

Section: Discussionmentioning

confidence: 53%

“…At the end of the Second World War, Cleveland in a post war summary reported that it was associated with a very high complication rate, and the devices were removed from American military hospitals (4). More recent reports have also documented a high complication rate when external fixation has been used to treat military injuries (6,7,11), but this must be balanced against the fact that many of these injuries are highly contaminated and associated with significant tissue injury. As such they would be expected to have a high complication rate anyway.…”

Section: Introductionmentioning

confidence: 99%

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Early Failure Of External Fixation In The Management Of War Injuries

Clasper¹,

Phillips²

2005

J R Army Med Corps

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Objective To review external fixation in the management of war injuries. Method We prospectively followed up 15 external fixators (14 patients) applied in the management of war injuries. All these patients were treated at 202 Field Hospital during the 2003 Gulf Conflict. Results Of the 15 fixators, 13 (86.7%) required early revision or removal due to complications of the injury or the fixator. Instability was a problem with 10 fixators (67%), pin loosening was noted with 5 fixators (33%) involving twelve pins, and a significant pin track infection developed at 14 pin sites (3 fixators – 20%), which failed to resolve despite intravenous antibiotics. Conclusions This study demonstrates a very high early complication rate of external fixation in the management of military injuries and cautions against its universal acceptance. If used, consideration must be given to the optimum time of frame application, whether at the time of initial debridement or at a later operation, and the optimal frame design, which will depend on the specific bone and fracture pattern. Pin site care must also be considered, particularly with the restrictions imposed by the military environ-ment.

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Section: Discussionmentioning

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Early Failure Of External Fixation In The Management Of War Injuries

Clasper¹,

Phillips²

2005

J R Army Med Corps

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“…This is despite the fact that few reports have any follow-up data, and those that do report a pin tract infection rate of up to 35.3%, and osteomyelitis in 7.8% of patients (Dubravko et al 1994). Fracture healing is often delayed, with a non-union rate of 9.8% (Has et al 1995).…”

Section: Complications Of External Fixation For Military Injuriesmentioning

confidence: 99%

“…Dubravko et al reported the use of external fixation during the war in Croatia, (Dubravko et al 1994). Of the 116 fixations, complications occurred in 79 (68.1%); pin tract infection occurred in 35.3% of all patients, and pin tract osteomyelitis in 7.8% of patients.…”

Section: Complications Of External Fixation For Military Injuriesmentioning

confidence: 99%

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The Interaction of Projectiles with Tissues and the Management of Ballistic Fractures

Clasper

2001

J R Army Med Corps

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Wounds to the limbs are the commonest injuries seen during armed conflict and injury results from the transfer of energy from the missile to the tissues. There are a number of factors that determine the transfer of energy, and thus the extent of wounding. These include the velocity of the missile, its shape and stability, and the tissue through which the missile passes. Many of the wounds involve bone, and because of the interaction of missiles with bone, significant fractures can occur.In many previous conflicts amputation was considered the treatment of choice for many limb injuries, but with recent advances in the management of severe open fractures, many of these limbs are now salvageable. Whilst the basic principles of the initial débridement remain unchanged, techniques of fracture stabilisation and definitive soft tissue cover have changed, and it is necessary to consider these in relation to military fractures. Definitive soft tissue closure can be safely delayed until evacuation further down the medical chain, but stabilisation of the fracture must be considered at the time of initial surgery. Many of the advances in fracture management may be unsuitable for use in a military environment due to logistical constraints. In addition it is likely that wound infection will be more common with military injuries, and this will influence the treatment. This paper considers the interaction of missiles with soft tissue and bone, and discusses possible methods of fracture stabilisation in the military environment.

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