Zeev Eshkol1, Kalman Katz. 1. Department of Orthopedic Surgery, Rabin Medical Center, Beilinson Campus, Petah Tiqva 49100, Israel.
Abstract
BACKGROUND: The management of penetrating wounds caused by suicide bomber bone fragments, contaminated by infectious viruses such as hepatitis or human immunodeficiency virus, is a new medical challenge. The aim of this study was to review the literature and add our experience in the treatment of such wounds. PATIENTS AND METHODS: The files of 94 patients with multiple penetrating fragment injuries of the musculoskeletal system were reviewed. Following any necessary life-saving procedures, the patients underwent wound debridement with delayed wound closure. Broad-spectrum antibiotic treatment was started immediately on admission, and all patients were inoculated with antitetanus toxin and hepatitis B vaccine. RESULTS: The most common injuries were multiple lacerations caused by penetration of small metal fragments. Those that were not removed on initial debridement and continued to cause pain were removed during follow-up. Twenty-three patients presented with 49 open fractures caused by the penetrating nails or impact against other objects. Three cases were complicated by chronic osteomyelitis. Three patients presented with injuries caused by bone fragments from the suicide bomber. Samples of bone from one suicide bomber tested positive for hepatitis B virus. None of the patients developed clinical signs of hepatitis B, human immunodeficiency virus or other severe infections during follow-up. CONCLUSIONS: The penetration of biologic material may transmit severe incurable infectious disease.
BACKGROUND: The management of penetrating wounds caused by suicide bomber bone fragments, contaminated by infectious viruses such as hepatitis or human immunodeficiency virus, is a new medical challenge. The aim of this study was to review the literature and add our experience in the treatment of such wounds. PATIENTS AND METHODS: The files of 94 patients with multiple penetrating fragment injuries of the musculoskeletal system were reviewed. Following any necessary life-saving procedures, the patients underwent wound debridement with delayed wound closure. Broad-spectrum antibiotic treatment was started immediately on admission, and all patients were inoculated with antitetanus toxin and hepatitis B vaccine. RESULTS: The most common injuries were multiple lacerations caused by penetration of small metal fragments. Those that were not removed on initial debridement and continued to cause pain were removed during follow-up. Twenty-three patients presented with 49 open fractures caused by the penetrating nails or impact against other objects. Three cases were complicated by chronic osteomyelitis. Three patients presented with injuries caused by bone fragments from the suicide bomber. Samples of bone from one suicide bomber tested positive for hepatitis B virus. None of the patients developed clinical signs of hepatitis B, human immunodeficiency virus or other severe infections during follow-up. CONCLUSIONS: The penetration of biologic material may transmit severe incurable infectious disease.
Authors: Jonathan D Gates; Sandra Arabian; Paul Biddinger; Joe Blansfield; Peter Burke; Sarita Chung; Jonathan Fischer; Franklin Friedman; Alice Gervasini; Eric Goralnick; Alok Gupta; Andreas Larentzakis; Maria McMahon; Juan Mella; Yvonne Michaud; David Mooney; Reuven Rabinovici; Darlene Sweet; Andrew Ulrich; George Velmahos; Cheryl Weber; Michael B Yaffe Journal: Ann Surg Date: 2014-12 Impact factor: 12.969