Supracondylar missile fractures of the femur

We present the results of the surgical treatment of 50 supracondylar missile fractures of the femur in 48 patients wounded in the territory of the former Yugoslavia in the period June 1991-October 1995. The injuries were caused by bullets in 28 (58.3%) patients and by fragments of mines or other explosive devices in 20 (41.7%) patients. In nine (18.0%) missile supracondylar fractures there were associated fractures of articular surfaces in the knee-joint. Neurovascular bundle injuries were present in 19 (38.0%) and vascular injuries alone in 17 (34.0%) limbs. Bone fragments were stabilized by external fixation in 43 (86.0%) and by plaster of Paris in five (10.0%) limbs. Primary reconstruction of large blood vessel was necessary in 16 (32.0%) limbs. In total eight (16.0%) above knee amputations were done. Coverage of soft tissue defects was required in 19 (38.0%) limbs. Early and late postoperative complications occurred in 26 (52.0%) limbs. Additional surgical procedures were necessary in 15 patients. Definitive results showed a large number of limb shortenings, nerve paralyses and contractures of the knee-joint.

[Dislocation of the knee joint]

Dislocations are the rarest but the most severe injuries of the knee joint. Six patients with traumatic knee joint dislocation were treated at the Clinic for Traumatology and Orthopedics of the Military Medical Academy in the period January 1989-November 1998. Popliteal artery was injured in 3 patients. The injuries required reconstruction and the treatment in 1 patient ended with upper leg amputation. In one case the diagnosis was irreducible lateral dislocation. Surgical reparation--reconstruction of ligamentary apparatus was performed in 4 patients. Concerning the knee joint stability satisfactory results were achieved. Knee joint dislocations are very severe injuries requiring thorough diagnosis of the possible injury of neurovascular bundle and surgical treatment.

Missile injuries of the knee joint

The results of the treatment of missile injuries of 170 knees in 162 patients are analyzed. The injuries were caused by infantry weapon missiles in 52(32.1%) and by fragments of mine or explosive devices in 110(67.9%) patients. The most frequent were penetrating injuries of the joint with multifragment fractures which in 15.8% cases were associated with injuries of the neurovascular bundle. Stabilization of bone fragments was required in 111(65.3%) knees. Stabilization was done by external fixation in 42(37.8%) and by plaster of Paris in 69(62.2%) knees. Additional mini osteosynthesis was required in 13(30.9%) knees stabilized by external fixation and in 3(4.3%) knees stabilized by plaster of Paris. Amputations were performed in 13(7. 6%) injured knees. During the postoperative period local and general complications occurred in 27(16.6%) patients. The most frequent local complications were suppurative articular infections requiring repeated surgery. Soft tissue defect covering was necessary in 53(33. 1%) patients. The poor late results were present in missile fractures of the knee. The most frequent were degenerative changes with bone defects. The possible surgical solutions in such cases are arthrodesis or total endoprosthesis implantation.

Primary surgical treatment of war injuries of major joints of the limbs

We present the results of primary surgical treatment of war injuries of major joints in 339 patients, wounded in the territory of the former Yugoslavia in the period June 1991-October 1995. The total number of surgically treated joints was 358. The injuries were inflicted by the fragments of explosive devices in 176 (51.9%) patients and by bullets in 125 (36.9%) patients. A single wound was present in 160 (47.2%) and several wounds in 176 (51.9%) patients; 276 (77.1%) patients had injuries of articular bone. The most frequently injured joints were knee joint 167 (46.6%) and elbow joint 72 (20.1%). Associated neurovascular injuries were present in 68 (18.9%) patients. Postoperative bone fragment stabilization was required in 254 (70.9%) joints. Stabilization was by plaster of Paris in 148 (58.2%) and external fixation in 85 (33.4%) patients. Postoperative course was uneventful in 262 (77.3%) while postoperative complications occurred in 77 (22.7%) patients. Amputations were performed in 15 (4.4%) patients. After the primary surgical treatment 254 (74.9%) patients were discharged and directed to rehabilitation or home care and 81 (23.9%) patients required additional reconstructive surgery for bone and soft tissue defects.

Subtrochanteric missile fractures of the femur

The treatment results of subtrochanteric missile fractures of the femur in 41 casualties are analyzed. The wounds were inflicted by infantry weapon missiles in 29 (70.7%) and by fragments of mine or explosive devices in 12 (29.3%) casualties. The associated neurovascular bundle injuries were present in 11 (26.8%) patients. Fracture stabilization was done by external fixation in 25 (62.5%): group A; and by plaster of Paris in 15 (37.5%) patients: group B. The postoperative period was uneventful in 14 (35.0%) and early or late complications occurred in 26 (65.0%) patients. Bone infection developed in six (15.0%) and fractures did not heal in four (10.0%) patients. Complications were present in 13 (52.0%) patients from group A and in 13 (86.7%) patients from group B. Delayed fracture healing and fracture nonunion were present in group A and contractures of large joints in group B. Subtrochanteric missile fractures of the femur present very severe injuries where the treatment is followed by a very high percentage of complications. External fracture fixation in this region facilitates the care, stability, early covering of soft tissue defects and early physical therapy.

Arthroscopy of the knee in war injuries

The results of arthroscopic removal of bullets and explosive ordnance fragments from the knee joint are presented. The operations were performed on 18 patients injured in battle operations in the former Yugoslavian territory in the period September 1991-October 1994. The indications for arthroscopic operations were positive radiographic findings, a locked knee, pain, effusion, instability and painful movement. In 13 patients, bullets and explosive ordnance fragments were removed arthroscopically, while in five patients, the clinic findings were found to be misleading. There were no complications from the arthroscopic surgery.