Treating fractures in upper limb gunshot injuries: The Cape Town experience

Engelmann, Esmee W M; Roche, Stephen; Maqungo, Sithombo; Naude, DuPreez; Held, Michael

doi:10.1016/j.otsr.2018.11.002

Cited by 26 publications

(14 citation statements)

References 23 publications

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“…In contrast to previous Research results [10,11,12,13,14,15], showed the lack of conventional Surgical tactics for low-energy gunshot wounds, as well as the following authors [16,17,18,19,20], are supporters of strict adherence to the medical-diagnostic algorithm for providing medical care to the wounded with combat surgical trauma with soft tissue defects. The studies have confirmed the need [26,27,28,29,30,31] to perform complex reconstructive and restorative interventions to repair large and very large soft tissue defects at the Role 4.…”

Section: Discussioncontrasting

confidence: 63%

Organization of sorting and surgery of wounds with soft tissue defects during the joint force surgery

Хоменко

Лурін

Коrol

et al. 2020

J Educ Health Sport

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Introduction. The experience of providing medical care during the Anti-terrorist operation in eastern Ukraine showed that in the structure of modern combat surgical trauma gunshot wounds with soft tissue defects are between 64.9-68.2%, of which 36.4-37.5% are small and medium, 28.5-30.7% are large and very large defects. Aim: To improve the results of providing surgical care to the wounded with soft tissue defects by introducing a variety of surgical tactics of wound closure to the medical care levels. Material and Methods. The total array of the study was 2537 wounded with shrapnel, bullet and mine injuries from April 2014 to September 2018. The determination of surgical tactics for closing soft tissue defects was performed at the basis of metric classification taking into account the area, volume and anatomical areas of the lesion. Results. The combination of metric characteristics of wound defects by area, volume with localization of wounds in a single classification allowed the offer of a comprehensive approach to sorting the wounded at the level of medical care and to determine further surgical tactics to close soft tissue defects. In accordance with the sorting and evacuation purposes, the wounded with gunshot wounds to the foot and hand (third zone of injury) were treated in specialised centres to the fourth level of medical care. In the case of medium and large wounds of the thigh, leg, shoulder and forearm, medical care was provided at the second and 261 third levels. And in the case of large and very large wounds of the specified localisation was provided in specialised clinics of the fourth level. Conclusions. The introduction of differentiated surgical tactics in the wounded with soft tissue defects at the levels of medical care has improved functional results: increase the proportion of good from 46.9% to 53.7%, reduce the relative number of unsatisfactory from 18.8% to 11, 6%.

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Section: Discussioncontrasting

confidence: 63%

Organization of sorting and surgery of wounds with soft tissue defects during the joint force surgery

Хоменко

Лурін

Коrol

et al. 2020

J Educ Health Sport

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“…Studies reported the rates of extremity fractures due to gunshot wounds as 59%, 34.5% and 56.7% [3,11,22]. In our study, there were four fractures in the upper and 15 fractures in the lower extremities, as determined by radiological methods.…”

Section: Discussionsupporting

confidence: 47%

“…Dorlac et al [24] found that more than half of the patients who were injured by firearms died from excessive blood loss due to artery damage in the lower extremity. In the study conducted by Engelmann et al [22], neurovascular injuries were detected in 43.1% of patients. In this study, two patients with upper extremity injuries had radial artery and one patient with lower extremity injury had crural artery injury.…”

Section: Discussionmentioning

confidence: 91%

Analysis of patients admitted to the emergency department with gunshot wounds

Ertekin¹

2021

Journal of Surgery and Medicine

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“…However, published data concerning the decision-making and treatment outcomes of acromion fractures are retrospective and do not compare operative versus non-operative treatment [ 20 ]. The latter treatment along with surgical implantation of plates designed for other anatomic regions have been employed at our center to treat acromion fractures before the usage of scapula anatomical plates [ 21 ]. There is no evidence, in the literature, regarding pre-contoured [ 22 ] scapula plate’s potential to effectively treat the fracture.…”

Section: Discussionmentioning

confidence: 99%

Quantitative fit analysis of acromion fracture plating systems using three-dimensional reconstructed scapula fractures – A multi-observer study

Charilaou

Dey

Burger

et al. 2021

SICOT-J

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Introduction: Surgical treatment of displaced acromial and scapula spine fractures may be challenging due to the bony anatomy and variable fracture patterns. This difficulty is accentuated by the limitations of the available scapular plates for fracture fixation. This study compares the quantitative fitting of anatomic scapular plates and clavicle plates, using three-dimensional (3D) printed fractured scapulae. Methods: Fourteen scapulae with acromion and spine fractures were used for this study. Computerized tomographic (CT) scans of the fractured scapulae were obtained from the Philips picture archiving and communication system (PACS) database of patients admitted to a tertiary teaching hospital in Cape Town, South Africa between 2012 and 2016. The reconstructed scapulae were 3D printed and the anatomical acromion and clavicle plates were templated about the fracture regions. The fit assessment was performed by five observers who classified the plates as no-fit, intermediate fit, and anatomical fit according to the surgical guidelines. Results: The 6-hole anterior clavicle plate performed better than any of the scapular plates as they were able to fit 45.7% of the fractured acromion, including the spine. Among the pre-contoured anatomical scapula plates, both the short and the long acromion plates could fit only 27.3% of the fractured acromion. The intraclass correlation coefficient was 0.965 suggesting excellent consensus among the five observers. Conclusion: Clavicle plates were found to be better suited to fit around a scapula fracture in its acromion and spine region.

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Treating fractures in upper limb gunshot injuries: The Cape Town experience

Cited by 26 publications

References 23 publications

Organization of sorting and surgery of wounds with soft tissue defects during the joint force surgery

Organization of sorting and surgery of wounds with soft tissue defects during the joint force surgery

Analysis of patients admitted to the emergency department with gunshot wounds

Quantitative fit analysis of acromion fracture plating systems using three-dimensional reconstructed scapula fractures – A multi-observer study

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