BACKGROUND: More than 75% of all injuries in modern wars are injuries of the extremities, usually with highly contaminated wounds and major soft tissue destruction. In this review, we present the late functional results for 35 of 41 wounded patients who sustained solitary war injuries of the extremities with open fractures. METHODS: During a 6-month period from August 1991 to February 1992, of a total of 1,050 injured patients, 49 wounded patients with isolated open fractures of the extremities were treated in General Hospital Nova Gradiska (Nova Gradiska, Croatia). The mean age was 34 years (range, 17-85 years); 44 wounded patients (90%) were male and 37 (76%) were soldiers. With primary amputations for 8 (16%) of 49 injured patients, external fixation was performed for 27 wounded patients (66%); primary internal fixation was applied for eight wounded patients (19.5%). After 12 years, 35 (85%) of the injured patients were available for evaluation concerning (a) fractured bone nonunion, (b) osteomyelitis, (c) late amputation, (d) nerve palsy, and (e) function. RESULTS: Osteomyelitis occurred for five patients (12%), only one with primary external fixation. In two cases of delayed conversion of external fixation to internal fixation, osteomyelitis occurred, requiring external fixator restoration. This has been no recurrence of osteomyelitis in the past 5 years and, after 12 years, more than three-fourths of wounded patients showed no or mild reduction of function of related proximal and distal joints. According to Index of Independence in Activities of Daily Living scores, grade B was found for only two wounded patients, with grade A for the others. CONCLUSION: The application of external fixation is the first and definitive choice of treatment for war-related open fractures of extremities, producing good late functional results. Conversion of external fixation to internal fixation leads to osteomyelitis, demanding another operation and application of secondary external fixation.
BACKGROUND: More than 75% of all injuries in modern wars are injuries of the extremities, usually with highly contaminated wounds and major soft tissue destruction. In this review, we present the late functional results for 35 of 41 wounded patients who sustained solitary war injuries of the extremities with open fractures. METHODS: During a 6-month period from August 1991 to February 1992, of a total of 1,050 injured patients, 49 wounded patients with isolated open fractures of the extremities were treated in General Hospital Nova Gradiska (Nova Gradiska, Croatia). The mean age was 34 years (range, 17-85 years); 44 wounded patients (90%) were male and 37 (76%) were soldiers. With primary amputations for 8 (16%) of 49 injured patients, external fixation was performed for 27 wounded patients (66%); primary internal fixation was applied for eight wounded patients (19.5%). After 12 years, 35 (85%) of the injured patients were available for evaluation concerning (a) fractured bone nonunion, (b) osteomyelitis, (c) late amputation, (d) nerve palsy, and (e) function. RESULTS:Osteomyelitis occurred for five patients (12%), only one with primary external fixation. In two cases of delayed conversion of external fixation to internal fixation, osteomyelitis occurred, requiring external fixator restoration. This has been no recurrence of osteomyelitis in the past 5 years and, after 12 years, more than three-fourths of wounded patients showed no or mild reduction of function of related proximal and distal joints. According to Index of Independence in Activities of Daily Living scores, grade B was found for only two wounded patients, with grade A for the others. CONCLUSION: The application of external fixation is the first and definitive choice of treatment for war-related open fractures of extremities, producing good late functional results. Conversion of external fixation to internal fixation leads to osteomyelitis, demanding another operation and application of secondary external fixation.