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Liang H, Chen B, Duan S, Yang L, Xu R, Zhang H, Sun M, Zhou X, Liu H, Wen H, Cai Z. Treatment of complex limb fractures with 3D printing technology combined with personalized plates: a retrospective study of case series and literature review. Front Surg 2024; 11:1383401. [PMID: 38817945 PMCID: PMC11137251 DOI: 10.3389/fsurg.2024.1383401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/09/2024] [Indexed: 06/01/2024] Open
Abstract
Background In recent years, 3D printing technology has made significant strides in the medical field. With the advancement of orthopedics, there is an increasing pursuit of high surgical quality and optimal functional recovery. 3D printing enables the creation of precise physical models of fractures, and customized personalized steel plates can better realign and more comprehensively and securely fix fractures. These technologies improve preoperative diagnosis, simulation, and planning for complex limb fractures, providing patients with better treatment options. Patients and methods Five typical cases were selected from a pool of numerous patients treated with 3D printing technology combined with personalized custom steel plates at our hospital. These cases were chosen to demonstrate the entire process of printing 3D models and customizing individualized steel plates, including details of the patients' surgeries and treatment procedures. Literature reviews were conducted, with a focus on highlighting the application of 3D printing technology combined with personalized custom steel plates in the treatment of complex limb fractures. Results 3D printing technology can produce accurate physical models of fractures, and personalized custom plates can achieve better fracture realignment and more comprehensive and robust fixation. These technologies provide patients with better treatment options. Conclusion The use of 3D printing models and personalized custom steel plates can improve preoperative diagnosis, simulation, and planning for complex limb fractures, realizing personalized medicine. This approach helps reduce surgical time, minimize trauma, enhance treatment outcomes, and improve patient functional recovery.
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Affiliation(s)
- Hairui Liang
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Beibei Chen
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Siyu Duan
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Lei Yang
- School of Pharmacy, Inner Mongolia Medical University, Inner Mongolia Autonomous Region, Shenyang, China
| | - Rongda Xu
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - He Zhang
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Ming Sun
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Xueting Zhou
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Hanfei Liu
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Hang Wen
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Zhencun Cai
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
- Key Laboratory of Human Ethnic Specificity and Phenomics of Critical Illness in Liaoning Province, Shenyang Medical College, Shenyang, China
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Scholl Schell M, Xavier de Araujo F, Silva MF. Physiotherapy assessment and treatment of patients with tibial external fixator: a systematic scoping review. Disabil Rehabil 2024; 46:1673-1684. [PMID: 37118977 DOI: 10.1080/09638288.2023.2202419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/08/2023] [Indexed: 04/30/2023]
Abstract
PURPOSE To map evidence regarding physiotherapy assessment and treatment of patients with tibial external fixator (EF), and to point out literature gaps for further research. METHODS Systematic scoping review conducted in four databases. We included both experimental and non-experimental studies involving patients with tibial EF and outcomes of interest. We recorded study design, population, sample size, sample age, reason for EF use, type of surgery, type of EF used, instruments used for assessing function, pain, quality of life, satisfaction, psychosocial aspects, and physiotherapy treatment descriptions from included studies. We categorised data accordingly to outcomes assessed and physiotherapy treatments description. RESULTS Eighty-six studies were included involving 3070 patients. Causes of fixator use were traumatic conditions, acquired and congenital deformities, and non-traumatic conditions, like compartmental osteoarthritis. Function was assessed in about three-quarters of included studies, though other outcomes were not presented in most studies. Only one study described satisfactorily the physiotherapy treatment. Almost half of the studies did not provide any description of the rehabilitation process. CONCLUSIONS There is little evidence about the assessment of function, pain, quality of life, satisfaction, psychosocial aspects, and other outcomes in tibial EF patients. Physiotherapy treatment in these patients is poorly reported.Protocol registration: Open Science Framework: doi:10.17605/OSF.IO/UT2DA.
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Affiliation(s)
- Mauricio Scholl Schell
- Physiotherapy Department, Post Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | | | - Marcelo Faria Silva
- Physiotherapy Department, Post Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
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Chatard M, Bey E, Baus A. [Current role of the latissimus dorsi flap in traumatology: Analysis of the activity of a plastic surgery department in a military hospital]. ANN CHIR PLAST ESTH 2024; 69:249-257. [PMID: 37673772 DOI: 10.1016/j.anplas.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023]
Abstract
Reconstructive surgery's workhorse, the latissimus dorsi flap is increasingly abandoned in favour of fasciocutaneous flaps. The purpose of this study was to analyse the methods used to perform this flap and the evolution of its indications in order to define its current place in traumatology. Forty-four cases were recorded retrospectively from January 2000 to December 2020 at HIA Percy, including 37 cases of free flaps, mainly performed for reconstruction of extensive loss of substance with bone and/or joint exposure. It was also performed in 10.8% of cases for salvage after failure of an alternative reconstruction solution. This analysis confirms the value of the latissimus dorsi flap in cases of significant substance loss in the lower limb, but also in burn patients for functional rehabilitation or to allow early rehabilitation.
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Affiliation(s)
- M Chatard
- Service de chirurgie plastique, reconstructrice et esthétique, département de chirurgie plastique, maxillo-faciale et reconstructrice, CHRU Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, Nancy, France; Faculté de médecine de Nancy, 9, avenue de la Forêt de Haye, Vandœuvre-lès-Nancy, France.
| | - E Bey
- Service de chirurgie plastique, reconstructrice et esthétique, département de chirurgie reconstructrice, HIA Percy, Clamart, France; Service de santé des armées, école du Val-de-Grâce, Paris, France
| | - A Baus
- Service de chirurgie plastique, reconstructrice et esthétique, département de chirurgie reconstructrice, HIA Percy, Clamart, France; Service de santé des armées, école du Val-de-Grâce, Paris, France
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Pourabbas B, Emad J, Dehghani J, Heidari S, Vosoughi AR. Mechanical evaluation of the effect of the rod to rod distance on the stiffness of uniplanar external fixator frames. Musculoskelet Surg 2023; 107:397-403. [PMID: 37029888 DOI: 10.1007/s12306-023-00782-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/26/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE To investigate the effect of the rod-to-rod distance on the mechanical stability of single-rod and double-rod external fixator frames. METHODS Four different constructs, one single-rod and three double-rod constructs with different rod-rod distances, were subjected to the axial, bending, and torsional forces. The stiffness of different configurations was calculated. RESULTS Single-rod configuration had statistically the lowest stiffness when subjected to the axial, bending, and torsional forces. Maximum stiffness against the axial and anterior-posterior bending forces was achieved when the rod-rod distance was adjusted to 50 mm (halfway between the first rod and the end of the Schanz pins). There was no statistically significant difference in lateral bending stiffness among different double-rod configurations (p value: 0.435). The maximum stiffness against torsional forces was achieved when the rod-rod distance was adjusted to 100 mm (the second rod at the end of the Schanz pins). CONCLUSION Double-rod uniplanar external fixator frames are significantly stiffer than the single-rod constructs, and however, the rod-rod distance can significantly affect the construct stiffness. We found that a frame with 50 mm rod-rod distance was the optimum fixator among tested configurations that allowed a balance between axial, bending, and torsional stiffness of the construct.
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Affiliation(s)
- B Pourabbas
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - J Emad
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - S Heidari
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - A R Vosoughi
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Tibia fracture management in low-resource settings using the External Fixation and Traction Device of the Guinean Military Health Service. Orthop Traumatol Surg Res 2022; 108:103377. [PMID: 35907623 DOI: 10.1016/j.otsr.2022.103377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/05/2021] [Accepted: 03/17/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The authors analyzed results over a 7-year period for a locally manufactured external fixation and traction device (EFTD) used in tibial fracture. Three models were used, depending on the medical and technological context of the healthcare structure in question. The aim of the present study was to reports results for tibial fracture treated by EFTD in low-resource settings. MATERIALS AND METHODS A multicenter observational study was conducted for the period 2008-2015 in a series of 34 tibial fractures (22 right, 12 left, with 1 bilateral) in 33 young adults (28 male, 5 female; mean age, 42.2 years). Nineteen were closed fractures and 15 open. The 11 recent open fractures comprised 2 Cauchoix-Duparc type I, 3 type II and 6 type III; the 4 older open fractures were infected. Four patients were lost to follow-up. RESULTS Seventeen of the patients with closed fracture had very good results, in 75% (6/8) of shaft fractures and 55.55% (5/9) of complex metaphyseal-epiphyseal fractures. In infected fractures older than 48h, there were good results in 25% of cases. In recent open fractures, there were 100% (2/2), 66.6% (2/3) and 20% (1/5) good results for types I, II and III respectively. Five patients showed malunion, well-tolerated functionally. Mean time to bone healing was 16 weeks (range, 12-72 weeks). CONCLUSION In developing countries, the pitfall in treating open fractures is delayed surgery due to patients' socioeconomic situation and to underequipment. The EFTD is a promising technique, readily available at low cost, easy to implement and with minimal iatrogenesis. LEVEL OF EVIDENCE IV, prospective observational study.
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Rigal S. Stratégie de prise en charge des fracas des membres inférieurs en chirurgie de guerre. Réparé ou amputé : le soldat debout. BULLETIN DE L'ACADÉMIE NATIONALE DE MÉDECINE 2022. [DOI: 10.1016/j.banm.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Masquelet technique in military practice: specificities and future directions for combat-related bone defect reconstruction. Mil Med Res 2022; 9:48. [PMID: 36050805 PMCID: PMC9438145 DOI: 10.1186/s40779-022-00411-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/15/2022] [Indexed: 11/28/2022] Open
Abstract
Because of its simplicity, reliability, and replicability, the Masquelet induced membrane technique (IMT) has become one of the preferred methods for critical bone defect reconstruction in extremities. Although it is now used worldwide, few studies have been published about IMT in military practice. Bone reconstruction is particularly challenging in this context of care due to extensive soft-tissue injury, early wound infection, and even delayed management in austere conditions. Based on our clinical expertise, recent research, and a literature analysis, this narrative review provides an overview of the IMT application to combat-related bone defects. It presents technical specificities and future developments aiming to optimize IMT outcomes, including for the management of massive multi-tissue defects or bone reconstruction performed in the field with limited resources.
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Fernando PLN, Abeygunawardane A, Wijesinghe P, Dharmaratne P, Silva P. An engineering review of external fixators. Med Eng Phys 2021; 98:91-103. [PMID: 34848044 PMCID: PMC8660649 DOI: 10.1016/j.medengphy.2021.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/08/2021] [Accepted: 11/02/2021] [Indexed: 01/08/2023]
Abstract
Mechanical stability plays a key role in the effectiveness of external fixators. Strength and stiffness are the main factors which contributes towards stability. Modified configurations of linear, circular and hybrid fixators are investigated. Light weight composite materials are gradually replacing traditional metallic alloys. Existing research gaps in further optimizing external fixators are identified.
External Fixators are a common technique used to treat a variety of issues related to bones, predominantly due to its non-intrusive nature and versatility in terms of form and materials. While it is mainly used to treat open fractures, its other uses include limb lengthening, deformity correction, bone grafting, compression of non-unions and stabilization of dislocations. Its earliest use dates as far back as 400 BCE and has undergone significant improvements, focusing on both customization and optimization. These two aspects highlight the significance of complementing the orthopaedic requirements with engineering knowledge and its applications. Hence, this review paper aims to conduct an examination of recent developments of external fixators with a special focus on its structure, the usage of materials and biomechanical investigations using experimental and numerical techniques. The paper presents the existing level of engineering knowledge with regards to these aspects and identifies research gaps, which can improve the quality of the commonly used external fixators.
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Affiliation(s)
- P L N Fernando
- Centre for Biomedical Innovation, University of Moratuwa, Sri Lanka; Department of Mechanical Engineering, University of Moratuwa, Sri Lanka
| | | | | | | | - Pujitha Silva
- Centre for Biomedical Innovation, University of Moratuwa, Sri Lanka; Department of Electronic and Telecommunications Engineering, University of Moratuwa, Sri Lanka.
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Hosny GA, Ahmed ASAA, Tabl EA. Neglected infected floating knee injury: evaluation of closed reduction techniques. Eur J Trauma Emerg Surg 2021; 48:2331-2339. [PMID: 34215902 DOI: 10.1007/s00068-021-01745-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/29/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Floating knee injury is uncommon yet challenging problem. The situation is more complicated by presence of infection, open comminuted fractures, and late presentation. The aim of this study was to evaluate the closed reduction techniques by circular external fixation in a single stage to treat patients having infected neglected floating knee injuries. METHODS This retrospective study included 19 patients with a mean age of 34.4 years. The average duration from trauma to surgery was 51.1 days. All patients had at least one infected open fracture. According to Fraser's classification, ten injuries were type I, one case was type IIa, four were type IIb, and four were type IIc. Patients were treated by closed reduction techniques using the Ilizarov principles. Orthoplastic procedures were done in four cases in the same surgical setting. RESULTS Closed reduction and union were achieved in all cases with control of infection in 17 cases. The follow-up period averaged 41 months. The mean knee flexion was 97.4°. The complications included 5° extension lag (two cases), malunion (three cases), refracture (two cases), and DVT (four cases). The bone results were excellent (12 cases), good (5 cases), and poor (2 cases). The functional results were excellent (two cases), good (seven cases), acceptable (seven cases), and poor (three cases). CONCLUSIONS Closed reduction techniques using a circular frame provided a valid treatment option for infected neglected floating knee injuries in one stage without bone grafting. However, the high rate of complications and the diminished knee range of motion should be considered.
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Affiliation(s)
- Gamal Ahmed Hosny
- Department of Orthopaedic Surgery, Faculty of Medicine, Benha University, Farid Nada Street, Kalyubia, Benha, 13518, Egypt
| | - Abdel-Salam Abdel-Aleem Ahmed
- Department of Orthopaedic Surgery, Faculty of Medicine, Benha University, Farid Nada Street, Kalyubia, Benha, 13518, Egypt.
| | - Eslam Abdelshafi Tabl
- Department of Orthopaedic Surgery, Faculty of Medicine, Benha University, Farid Nada Street, Kalyubia, Benha, 13518, Egypt
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Knipper P, Bégué T, Pasquesoone L, Guerre E, Khonsari R, Girard P, Berger A, Khachatryan L, Tchaparian M. [Plastic surgery and fighting: Our experience during Nagorno-Karabakh war in 2020]. ANN CHIR PLAST ESTH 2021; 66:201-209. [PMID: 33966906 DOI: 10.1016/j.anplas.2021.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION This work relates the experience of three French surgical missions in the care of the war wounded during the armed conflict in Nagorno Karabakh which took place from September 27 to November 10, 2020. MATERIALS AND METHODS Three surgical missions were carried out in Armenia between October 2020 and January 2021. Surgeons intervened in different hospitals, at different times of the conflict and on various war wounds. RESULTS The presence of a plastic surgeon proved to be essential in the care of war wounded, especially in delayed emergency and secondary care. The ortho-plastic treatment offered during these missions has proven to be effective in the reconstruction of limbs. These missions made it possible to introduce the induced membrane technique of Masquelet AC in Armenia. During our visit to the Yerevan burn center, we mentioned the very probable use of white phosphorus as an etiology in several of the cases analyzed. CONCLUSION We relate the particular experience of civilian surgeons in the context of a modern armed conflict. The presence of a plastic surgeon proved to be indispensable in the care of war wounded and especially in their secondary reconstructions.
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Affiliation(s)
- P Knipper
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
| | - T Bégué
- Service de chirurgie orthopédique, traumatologique et réparatrice, hôpital Antoine-Béclère, AP-HP, université Paris-Saclay, 157, rue de la Porte-de-Triviaux, 92140 Clamart, France
| | - L Pasquesoone
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Roger-Salengro, avenue Émile-Laine, 59037 Lille, France
| | - E Guerre
- Service de chirurgie orthopédique, hôpital Roger-Salengro, avenue Émile-Laine, 59037 Lille, France
| | - R Khonsari
- Service de chirurgie maxillo-faciale et chirurgie plastique, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - P Girard
- Service de chirurgie orthopédique et traumatologique, groupe hospitalier public du sud de l'Oise, site de Creil, boulevard Laennec, 60100 Creil, France
| | - A Berger
- Service de chirurgie digestive et obésité, hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - L Khachatryan
- Service de chirurgie vasculaire, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - M Tchaparian
- Service de traumatologie, hôpital Roger-Salengro, avenue Émile-Laine, 59037 Lille, France
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de Lesquen H, Bergez M, Vuong A, Boufime-Jonqheere A, de l'Escalopier N. Adding the Capacity for an Intensive Care Unit Dedicated to COVID 19, Preserving the Operational Capability of a French Golden Hour Offset Surgical Team in Sahel. Mil Med 2020; 186:e30-e33. [PMID: 33169148 PMCID: PMC7717289 DOI: 10.1093/milmed/usaa273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/19/2020] [Accepted: 08/05/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction In April 2020, the military medical planning needs to be recalibrated to support the COVID-19 crisis during a large-scale combat operation carried out by the French army in Sahel. Material and Methods Since 2019, proper positioning of Forward Surgical Teams (FSTs) has been imperative in peer-to-near-peer conflict and led to the development of a far-forward surgical asset: The Golden Hour Offset Surgical Team (GHOST). Dedicated to damage control surgery close to combat, GHOST made the FST aero-mobile again, with a light logistical footprint and a fast setting. On 19 and 25 March 2020, Niger and Mali confirmed their first COVID-19 cases, respectively. The pandemic was ongoing in Sahel, where 5,100 French soldiers were deployed in the Barkhane Operation. Results For the first time, the FST had to provide, continuously, both COVID critical care and surgical support to the ongoing operation in Liptako. Its deployment on a Main Operating Base had to be rethought on Niamey, to face the COVID crisis and support ongoing operations. This far-forward surgical asset, embedded with a doctrinal Role-1, sat up a 4-bed COVID intensive care unit while maintaining a casualty surgical care capacity. A COVID training package has been developed to prepare the FST for this innovative employment. This far-forward surgical asset was designed to support a COVID-19 intensive care unit before evacuation, preserving forward surgical capability for battalion combat teams. Conclusion Far-forward surgical assets like GHOST have demonstrated their mobility and effectiveness in a casualty care system and could be adapted as critical care facilities to respond to the COVID crisis in wartime.
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Affiliation(s)
- Henri de Lesquen
- 4th Forward Surgical Team, French Military Health Service, France.,Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, 8300, Toulon, France
| | - Marie Bergez
- 4th Forward Surgical Team, French Military Health Service, France.,Département d'Anésthésie-Réanimation, Etablissement Hospitalier Civilo Militaire de Metz., 57070 Metz, France
| | - Antoine Vuong
- 183ème Antenne Medical de Mont de Marsan, 12ème Centre Médical des Armées de Bordeaux, 4000 Mont de Marsan, France
| | | | - Nicolas de l'Escalopier
- 4th Forward Surgical Team, French Military Health Service, France.,Department of Orthopedic, Traumatology and Reconstructive Surgery, PERCY Military Teaching Hospital, 92140, Clamart, France
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Baus A, Bich CS, Grosset A, de Rousiers A, Duhoux A, Brachet M, Duhamel P, Thomas M, Rogez D, Mathieu L, Bey E. Medical and surgical management of lower extremity war-related injuries. Experience of the French Military Health Service (FMHS). ANN CHIR PLAST ESTH 2020; 65:447-478. [DOI: 10.1016/j.anplas.2020.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/13/2020] [Indexed: 01/27/2023]
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Santolini E, Stella M, Divano S, Ceccarelli M, Vicenti G, Bizzoca D, Santolini F. Optimum timing of conversion from DCO to definitive fixation in closed fractures of the lower limb: When and how? Injury 2020; 54 Suppl 1:S63-S69. [PMID: 32958344 DOI: 10.1016/j.injury.2020.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/18/2020] [Accepted: 09/15/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In damage control orthopaedics (DCO), fractures are initially stabilised with external fixation followed by delayed conversion to definitive internal fixation. The aim of this study is to determine whether the timing of the conversion influences the development of deep infection and fracture healing in a cohort of patients treated by DCO after a closed fracture of the lower limb. Furthermore, we wanted to evaluate whether the one-stage conversion procedure is always safe. MATERIALS AND METHODS A retrospective cohort study was conducted at a single level 1 trauma centre. Ninety-four cases of closed fractures of lower limb treated by DCO subsequently converted to internal fixation from 2012 to 2019 were included. Development of deep infection, superficial infection, non-union and time to union were recorded. Patients were then divided into three groups according to the timing of conversion: Group A (<7 days), Group B (7-13 days), Group C (> 14 days). Comparison between groups was performed to assess intergroup variabilty. RESULTS The mean number of days between DCO and conversion was 6.7±4.52 (range 1-22). We observed one case of deep infection (1.1%), one case of non-union (1.1%), four cases of superficial infection (4.3%) and mean time to union was ±1.38 months. Comparison between groups demonstrated no significant correlation between timing of conversion and development of superficial or deep infection and non-union, while it highlighted that complexity of the fracture and longer surgical time of conversion procedure were significantly higher in Group C. CONCLUSIONS One-stage conversion to definitive internal fixation within 22 days from DCO is a safe and feasible procedure, which does not influence the incidence of infection or non-union.
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Affiliation(s)
- Emmanuele Santolini
- Academic Unit of Trauma and Orthopaedics, University of Genoa, Ospedale Policlinico San Martino, Largo R. Benzi 10 - 16132, Genoa, Italy.
| | - Marco Stella
- Orthopedics and Trauma Unit, Ente Ospedaliero Ospedali Galliera, Mura delle Cappuccine 14 - 16148, Genoa, Italy
| | - Stefano Divano
- Academic Unit of Trauma and Orthopaedics, University of Genoa, Ospedale Policlinico San Martino, Largo R. Benzi 10 - 16132, Genoa, Italy
| | - Michele Ceccarelli
- Academic Unit of Trauma and Orthopaedics, University of Genoa, Ospedale Policlinico San Martino, Largo R. Benzi 10 - 16132, Genoa, Italy
| | - Giovanni Vicenti
- Department of Neuroscience and Sense Organs, Orthopaedics Section, University of Bari Aldo Moro, Bari, Italy
| | - Davide Bizzoca
- Department of Neuroscience and Sense Organs, Orthopaedics Section, University of Bari Aldo Moro, Bari, Italy
| | - Federico Santolini
- Orthopedics and Trauma Unit, Emergency Department, Ospedale Policlinico San Martino, Largo R. Benzi 10 - 16132, Genoa, Italy
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Mathieu L, Potier L, Ndiaye R, Sene M, Mbaye E, Faye M, Niang CD. Soft tissue reconstruction in the leg by orthopedic surgeons: Practices at an African trauma center. Orthop Traumatol Surg Res 2020; 106:825-829. [PMID: 32534898 DOI: 10.1016/j.otsr.2020.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/17/2020] [Accepted: 03/27/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Soft-tissue coverage is a crucial step when treating open tibial fractures, which is often performed by orthopedic surgeons in a low resource setting. The objective of this study was to analyze the use of non-microsurgical flaps to treat such injuries in a West African trauma center. HYPOTHESIS Pedicled flaps are reliable procedures that can be used by any orthopedic surgeon for soft-tissue coverage in the leg. METHODS A retrospective study was conducted including patients treated between 2007 and 2011 for open tibial fractures or posttraumatic sequelae requiring flap coverage. Early flap necrosis and skin viability at the last follow-up were evaluated. RESULTS Fifty-five patients with mean age 34 years were included. They had 57 soft-tissue defects requiring flap reconstruction, 36 of which were infected. In total, 62 pedicled flaps were performed: 12 muscular flaps and 50 fasciocutaneous flaps, including 40 rotational flaps and 10 island flaps. The short-term result was successful in 55 flaps (89%). Seven flaps had partial or complete necrosis, including three soleus flaps and three lateral supramalleolar rotational flaps. At the average follow-up of 9 months, skin viability was inferior in the posttraumatic sequelae group and seemed to be altered by primary bone infection. CONCLUSION Soft-tissue coverage in the leg can be reliably achieved by orthopedic surgeons using simple and robust flaps that do not require pedicle dissection. Surgeon training in basic flap surgery is essential and still inadequate in emerging countries. LEVEL OF EVIDENCE IV, Retrospective study.
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Affiliation(s)
- Laurent Mathieu
- Department of orthopedics, traumatology and reconstructive surgery, Percy Military Hospital, Clamart, France; French Military Health Service Academy, École du Val-de-Grâce, Paris, France.
| | - Loïc Potier
- Department of orthopedics and traumatology, Clermont-Tonnerre Military Hospital, Brest, France
| | - René Ndiaye
- Department of orthopedics and traumatology, Hôpital Principal, Dakar, Sénégal
| | - Momar Sene
- Department of orthopedics and traumatology, Hôpital Principal, Dakar, Sénégal
| | - Elimane Mbaye
- Department of orthopedics and traumatology, Hôpital Principal, Dakar, Sénégal
| | - Moussa Faye
- French Military Health Service Academy, École du Val-de-Grâce, Paris, France; Department of orthopedics and traumatology, Hôpital Principal, Dakar, Sénégal
| | - Coumba Diouf Niang
- French Military Health Service Academy, École du Val-de-Grâce, Paris, France; Department of orthopedics and traumatology, Hôpital Principal, Dakar, Sénégal
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Bilichtin E, de Rousiers A, Durand M, de l'Escalopier N, Collombet JM, Rigal S, Mathieu L. Bone reconstruction by the induced membrane technique. What differences between conventional and ballistic trauma? Orthop Traumatol Surg Res 2020; 106:797-801. [PMID: 32376203 DOI: 10.1016/j.otsr.2019.10.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/17/2019] [Accepted: 10/07/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND The induced membrane technique (IMT) has been widely evaluated for reconstruction of post-traumatic bone defects. However, no specific evaluation was conducted in ballistic injuries. The objective of the present study was to compare IMT in conventional trauma (CT) versus ballistic trauma (BT) managed in a military trauma center. METHODS A retrospective study was conducted between 2009 and 2018 in patients treated by IMT for post-traumatic bone defects, whatever the defect location. Endpoints comprised bone union, residual infection, additional bone grafting and lower-limb amputation. RESULTS Thirty-six patients were included: 24 in the CT and 12 in the BT group. Demographics and injury pattern were similar in both groups, with open fracture and infected lesions predominating. The only significant difference was that tibial bone defects were larger in the BT group. Operative parameters and results were also similar. At a mean 24 months' follow-up, bone union rate was 83% in both groups, without significant differences in residual infection, complementary grafting or late amputation. CONCLUSION IMT is appropriate to bone reconstruction in the aftermath of ballistic trauma, with similar results to those obtained in conventional trauma. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Emilie Bilichtin
- Service de chirurgie orthopédique, traumatologie et chirurgie réparatrice des membres, hôpital d'Instruction des Armées Percy, 101, avenue Henri Barbusse, 92140 Clamart, France
| | - Arnaud de Rousiers
- Service de chirurgie orthopédique, traumatologie et chirurgie réparatrice des membres, hôpital d'Instruction des Armées Percy, 101, avenue Henri Barbusse, 92140 Clamart, France
| | - Marjorie Durand
- Institut de recherche biomédicale des armées, D19, 91220 Brétigny-sur-Orge, France
| | - Nicolas de l'Escalopier
- Service de chirurgie orthopédique, traumatologie et chirurgie réparatrice des membres, hôpital d'Instruction des Armées Percy, 101, avenue Henri Barbusse, 92140 Clamart, France
| | - Jean-Marc Collombet
- Institut de recherche biomédicale des armées, D19, 91220 Brétigny-sur-Orge, France
| | - Sylvain Rigal
- Service de chirurgie orthopédique, traumatologie et chirurgie réparatrice des membres, hôpital d'Instruction des Armées Percy, 101, avenue Henri Barbusse, 92140 Clamart, France; Chaire de chirurgie appliquée aux armées, École du Val-de-Grâce, 1, place Alphonse Laveran, 75005 Paris, France
| | - Laurent Mathieu
- Service de chirurgie orthopédique, traumatologie et chirurgie réparatrice des membres, hôpital d'Instruction des Armées Percy, 101, avenue Henri Barbusse, 92140 Clamart, France; Chaire de chirurgie appliquée aux armées, École du Val-de-Grâce, 1, place Alphonse Laveran, 75005 Paris, France.
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Giordano V, Giannoudis VP, Giannoudis PV. Current trends in resuscitation for polytrauma patients with traumatic haemorrhagic shock. Injury 2020; 51:1945-1948. [PMID: 32829760 DOI: 10.1016/j.injury.2020.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Vincenzo Giordano
- Hospital Municipal Miguel Couto, Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro - Rio de Janeiro - RJ - Brasil
| | - Vasileios P Giannoudis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom; NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, United Kingdom.
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Biomechanical comparison of minimally invasive treatment options for Type C unstable fractures of the pelvic ring. Orthop Traumatol Surg Res 2020; 106:127-133. [PMID: 31864961 DOI: 10.1016/j.otsr.2019.09.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/05/2019] [Accepted: 09/16/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The definite treatment of pelvic C fractures presents a widely discussed issue and undergoes continuous evolution. While the stabilization of the posterior ring has been studied extensively, the fixation of the anterior pelvic ring continuous to be rarely investigated. The importance of the simultaneous stabilization however lays in the earlier mobilization and prevention of long-term damage to the pelvis. Therefore we investigated four combinations of minimally invasive fixation techniques for unstable type C1-3 pelvic injuries and aimed to answer the following research questions: (1) what combination of fixation methods yields the highest stiffness and the least displacement? (2) Is the combination of a single sacroiliac screw (SI-screw) with a transiliac internal fixator (TIFI) a reasonable alternative to two SI-screws? (3) Is a modified unilateral anterior fixation comparable to a retrograde transpubic screw? HYPOTHESIS Minimally invasive fixation techniques provide sufficient biomechanical stability for type C pelvic fractures. METHODS Thirty synthetic full pelvises were divided into 5 groups, of which 4 groups were assigned a different osteosynthesis method and one was an intact pelvis used as reference (group 1: internal fixator+2 sacroiliac screws, group 2: internal fixator+transiliac internal fixator+1 sacroiliac screw, group 3: retrograde transpubic screw+2 sacroiliac screws, group 4: retrograde transpubic screw+transiliac internal fixator+1 sacroiliac screw). The pelvises underwent a protocol of cyclic loading between 100N and 200N, during which they were subjected to compression loads while the position of the fracture fragments was measured every 30 milliseconds. Displacement and stiffness were calculated for statistical analysis. RESULTS The minimally invasive fixation methods investigated in this study all provide sufficient biomechanical stability without one method being superior to the others (p [anterior displacement]=0.61 and p [posterior displacement]=0.88). Group 3 was allowed the least displacement (1.8±0.2mm for anterior and posterior fracture) for the treatment of a C1.3 fracture. The other fixation methods displayed the following dislocations (mm) of the anterior pelvic ring: group 1: 1.9±0.3, group 2: 2.1±0.4, group 4: 2.0±0.5. Posteriorly, the displacements (mm) were the following: group 1: 1.8±0.6, group 2: 1.9±0.2, group 4: 2.0±0.5. DISCUSSION The minimally invasive fixation methods investigated in this study all provide sufficient biomechanical stability without one method being superior to the others since differences were not significant regarding anterior and posterior displacements. Even if not significantly, we could reveal that out of all the methods tested the combination of 2 SI-screws with a retrograde transpubic screw (group 3) displayed the least displacement and highest stiffness. These techniques could therefore potentially improve patient's clinical outcome by reducing the surgical invasiveness and procedure time while providing sufficient biomechanical stability. LEVEL OF EVIDENCE III, comparative in vitro study.
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Pape HC, Halvachizadeh S, Leenen L, Velmahos GD, Buckley R, Giannoudis PV. Timing of major fracture care in polytrauma patients - An update on principles, parameters and strategies for 2020. Injury 2019; 50:1656-1670. [PMID: 31558277 DOI: 10.1016/j.injury.2019.09.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Sustained changes in resuscitation and transfusion management have been observed since the turn of the millennium, along with an ongoing discussion of surgical management strategies. The aims of this study are threefold: a) to evaluate the objective changes in resuscitation and mass transfusion protocols undertaken in major level I trauma centers; b) to summarize the improvements in diagnostic options for early risk profiling in multiply injured patients and c) to assess the improvements in surgical treatment for acute major fractures in the multiply injured patient. METHODS I. A systematic review of the literature (comprehensive search of the MEDLINE, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases) and a concomitant data base (from a single Level I center) analysis were performed. Two authors independently extracted data using a pre-designed form. A pooled analysis was performed to determine the changes in the management of polytraumatized patients after the change of the millennium. II. A data base from a level I trauma center was utilized to test any effects of treatment changes on outcome. INCLUSION CRITERIA adult patients, ISS > 16, admission < less than 24 h post trauma. Exclusion: Oncological diseases, genetic disorders that affect the musculoskeletal system. Parameters evaluated were mortality, ICU stay, ICU complications (Sepsis, Pneumonia, Multiple organ failure). RESULTS I. From the electronic databases, 5141 articles were deemed to be relevant. 169 articles met the inclusion criteria and a manual review of reference lists of key articles identified an additional 22 articles. II. Out of 3668 patients, 2694 (73.4%) were male, the mean ISS was 28.2 (SD 15.1), mean NISS was 37.2 points (SD 17.4 points) and the average length of stay was 17.0 days (SD 18.7 days) with a mean length of ICU stay of 8.2 days (SD 10.5 days), and a mean ventilation time of 5.1 days (SD 8.1 days). Both surgical management and nonsurgical strategies have changed over time. Damage control resuscitation, dynamic analyses of coagulopathy and lactate clearance proved to sharpen the view of the worsening trauma patient and facilitated the prevention of further complications. The subsequent surgical care has become safer and more balanced, avoiding overzealous initial surgeries, while performing early fixation, when patients are physiologically stable or rapidly improving. Severe chest trauma and soft tissue injuries require further evaluation. CONCLUSIONS Multiple changes in management (resuscitation, transfusion protocols and balanced surgical care) have taken place. Moreover, improvement in mortality rates and complications associated with several factors were also observed. These findings support the view that the management of polytrauma patients has been substantially improved over the past 3 decades.
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Affiliation(s)
- H-C Pape
- Department of Trauma, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
| | - S Halvachizadeh
- Department of Trauma, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - L Leenen
- Department of Trauma, University Medical Centre Utrecht, Suite G04.228, Heidelberglaan 100, 3585 GA, Utrecht, the Netherlands.
| | - G D Velmahos
- Dept. of Trauma, Emergency Surgery and Critical Care, Harvard University, Mass. General Hospital, 55 Fruit St., Boston, MA, 02114, USA
| | - R Buckley
- Section of Orthopedic Trauma, University of Calgary, Foothills Medical Center, 0490 McCaig Tower, 3134 University Drive NW Calgary, Alberta, T2N 5A1, Canada.
| | - P V Giannoudis
- Trauma & Orthopaedic Surgery, Clarendon Wing, A Floor, Great George Street, Leeds General Infirmary University Hospital, University of Leeds, Leeds, LS1 3EX, UK.
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Mathieu L, Bilichtin E, Durand M, de l’Escalopier N, Murison JC, Collombet JM, Rigal S. Masquelet technique for open tibia fractures in a military setting. Eur J Trauma Emerg Surg 2019; 46:1099-1105. [DOI: 10.1007/s00068-019-01217-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/21/2019] [Indexed: 02/03/2023]
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Guerado E, Cano JR, Fernandez-Sanchez F. Pin tract infection prophylaxis and treatment. Injury 2019; 50 Suppl 1:S45-S49. [PMID: 31003703 DOI: 10.1016/j.injury.2019.03.044] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 03/28/2019] [Indexed: 02/06/2023]
Abstract
Pin tract infection in external fixation (ExFix) is a frequent finding which can eventually lead to loosening, osteomyelitis and loss of fixation. Its diagnosis is based on high empiricism and low validity, although it is possible to distinguish between minor and major infection. The first is limited to soft tissues, whereas the latter includes bone involvement. The rate of infection after conversion of external fixation to intramedullary nailing (IMN) is not well known. Unfortunately, papers referring to infection after the conversion of ExFix to intramedullary nailing (IMN) are of evidence level IV or V. It is suggested that conversion of ExFix to IMN should be carried out in a 2 step regimen. The time interval of 2 step regimen is uncertain although some authors have recommended to occur within 9 days. There is no consensus as to which prophylaxis protocol should be applied prior to conversion. In order to throw more light into this important issue, registries capturing important related parameters to the development of infection should be established.
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Affiliation(s)
- Enrique Guerado
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Costa del Sol, University of Malaga, Marbella (Malaga), Spain.
| | - Juan Ramon Cano
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Costa del Sol, University of Malaga, Marbella (Malaga), Spain
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Risk factors and failures in the management of limb injuries in combat casualties. INTERNATIONAL ORTHOPAEDICS 2019; 43:2671-2680. [DOI: 10.1007/s00264-019-04329-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/31/2019] [Indexed: 11/25/2022]
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Alhammoud A, Maaz B, Alhaneedi GA, Alnouri M. External fixation for primary and definitive management of open long bone fractures: the Syrian war experience. INTERNATIONAL ORTHOPAEDICS 2019; 43:2661-2670. [PMID: 30905046 DOI: 10.1007/s00264-019-04314-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 02/15/2019] [Indexed: 11/25/2022]
Abstract
AIMS To report on the experience of one field hospital in using external fixation as a primary and definitive treatment for open long bone fractures during the Syrian war. METHODS A total of 955 patients with open long bone fractures (femur, tibia, humerus) who were operated and followed up at a field hospital in Aleppo, Syria, from 2011 to 2016, were retrospectively reviewed. Different types of uniplanar and some multiplanar external fixators were used solely as a primary and definitive tool until bone union was achieved. Union rate and infection rate were reported in association with age, gender, Gustilo/Anderson classification, type of fixator, and presence of neurovascular injuries. RESULTS Out of 955 patients, 404 (42.3%) continued to follow up until bone union or until removal of the external fixator. The average age was 27.5 ± 11 years, with 91.6% males and 8.2% females. The overall union rate was 68.3% (276/404), with 60.9% (95/156) in open femur, 70.3% (137/195) in open tibia, and 83% (44/53) in open humerus fractures. The overall infection rate was 16.7% (67/401), with 18.6% in open femur, 18.1% in open tibia, and 5.8% in open humerus fractures. CONCLUSION The use of external fixation for definitive treatment of open long bone shaft fractures caused by high energy trauma during times of wars or conflicts is reliable and should be used in early frontline intervention and in areas with limited access to resources.
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Affiliation(s)
| | | | | | - Mason Alnouri
- Department of Orthopaedic Surgery, Royal National Orthopaedic Hospital -NHS Trust, London, UK.
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Russo AP, Caubere A, Ghabi A, Grosset A, Mangin P, Rigal S, Mathieu L. Sequential management of tibial fractures using a temporary unicortical external fixator. SICOT J 2018; 4:39. [PMID: 30192226 PMCID: PMC6128168 DOI: 10.1051/sicotj/2018035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/29/2018] [Indexed: 12/27/2022] Open
Abstract
Introduction: The development of damage control orthopedics (DCO) procedures has led to the development of temporary unicortical external fixators (TUEFs) intended to limit deep infectious complications and facilitate early conversion to internal fixation. Methods: A retrospective study was conducted in two French military trauma centers, including on patients being treated for tibial fractures with a TUEF (UNYCO® − Orthofix®) followed by an early conversion to intramedullary nailing. Results: Eleven patients with an average age of 41 were included between September 2015 and June 2017. A total of 12 TUEFs were implanted for one closed fracture and 11 open fractures, including one type I, eight types II, and two Gustilo types IIIB. The indication of DCO was related to hemodynamic instability in three cases, to the severity of soft tissue lesions in eight cases, and to the context of treatment in one case. The conversion to IM nailing was made after an average of 7.6 days. No significant loss of reduction was observed until internal osteosynthesis, which was performed with “fixator in place” in ten cases. The coverage of Gustilo type III injuries was performed by free flap transfers at the same time as IM nailing. All the patients were reviewed with an average follow-up of 16.5 months. Bone union was achieved in all cases. Two IM nailing dynamizations were carried out, but no bone grafting was required. Two cases of pandiaphysitis were observed and treated without functional complications. Discussion: Despite a limited number of patients, this study demonstrates the reliability of the TUEF to maintain the reduction of tibial fractures and facilitate early conversion to IM nailing. Unicortical fixation does not prevent septic complications related to the severity of soft tissue injuries.
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Affiliation(s)
- Anne-Pauline Russo
- Department of Orthopedic Surgery, Traumatology and Reconstructive Surgery, Percy Military Hospital, Clamart, France
| | - Alexandre Caubere
- Department of Orthopedic Surgery and Traumatology, Sainte-Anne Military Hospital, Toulon, France
| | - Ammar Ghabi
- Department of Orthopedic Surgery, Traumatology and Reconstructive Surgery, Percy Military Hospital, Clamart, France
| | - Antoine Grosset
- Department of Orthopedic Surgery, Traumatology and Reconstructive Surgery, Percy Military Hospital, Clamart, France
| | - Philippe Mangin
- Department of Orthopedic Surgery, Traumatology and Reconstructive Surgery, Percy Military Hospital, Clamart, France
| | - Sylvain Rigal
- Department of Orthopedic Surgery, Traumatology and Reconstructive Surgery, Percy Military Hospital, Clamart, France - Department of Surgery, French Military Health Service Academy, École du Val-de-Grâce, Paris, France
| | - Laurent Mathieu
- Department of Orthopedic Surgery, Traumatology and Reconstructive Surgery, Percy Military Hospital, Clamart, France - Department of Surgery, French Military Health Service Academy, École du Val-de-Grâce, Paris, France
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