Reconstruction of Nonunion Tibial Fractures in War-Wounded Iraqi Civilians, 2006–2008

Abstract

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Introducing an antibiotic stewardship program in a humanitarian surgical hospital

“…The surgical program grew to include patients from Syria and Yemen. 5 Existing orthopedic infection was found to be common in patients at program entry, and the prevalence of multidrug-resistant pathogens was high. 6,7 To optimize management of chronic trauma-related infections, a medical-surgical strategy was established, a collaboration with a local microbiology laboratory was developed, and broad-spectrum antibiotics, including glycopeptides (vancomycin), extendedspectrum aminoglycosides (amikacin), and carbapenems (imipenem), active against multidrug-resistant strains, were introduced for the first time in an MSF hospital.…”

The short musculoskeletal functional assessment (SMFA) score amongst surgical patients with reconstructive lower limb injuries in war wounded civilians

“…We report on surgical outcomes using SMFA among civilian victims of violence in the Middle East for more than two years [9]. Among infected patients, we found those with a higher admission dysfunctional index also had an increase in the number of required surgeries, complication rates and the duration of stay.…”

“…We divided each of the admission groups (over 50 ADI and less than 50) into infected and not infected. We made this division because the presence of osteomyelitis may affect the number of surgeries, complication rate, and duration of stay for each patient [16,9]. It can also affect the follow up results in their home country.…”

“…Patients were discharged from the outpatient component of the project in Amman once they had: (1) no clinical or serological signs or symptoms of infection, (2) radiological studies demonstrating an early bridging callus; and (3) the ability to perform four basic activities of daily living, defined as being able to independently use the toilet, stand to cook, bath, and dress [9].…”

“…The questionnaire aims to provide a standardized measure of the patient's physical limitations, which can serve for both individual patient management and community-based outcome, studies [1]. The Mé decins Sans Frontiè res Operational Centre Paris (MSF-OCP) programme in Amman, Jordan is a tertiary care hospital and rehabilitation centre provides specialized reconstructive surgical care to war-wounded civilians in the region [9]. MSF has been performing reconstructive surgical care since August 2006 treating approximately 385 patients per year.…”