Grace Bauhahn1, Harald Veen2, Rigo Hoencamp3, Nelson Olim2, Edward C T H Tan4. 1. International Committee of the Red Cross, Geneva, Switzerland. grace.bauhahn@doctors.org.uk. 2. International Committee of the Red Cross, Geneva, Switzerland. 3. Ministry of Defence, Department of Surgery, Alrijne Medical Centre Leiderdorp, Leiden University Medical Centre, Leiden, The Netherlands. 4. Ministry of Defence, Department of Surgery-Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Abstract
INTRODUCTION: Malunion is a well-recognized complication of long-bone fractures which accounts for more than 25% of injuries in conflict zones. The aim of this study was to investigate the rate of malunion sustained by casualties with penetrating gunshot wounds in an International Committee of the Red Cross (ICRC) surgical substitution project in the Democratic Republic of Congo (DRC) and compare these results with current literature. METHODS: A retrospective cohort study was performed. All patients admitted to the ICRC facility between the periods of 01.10.2014 and 31.12.2015 with long-bone fractures caused by gunshot wound were included, and data were collected retrospectively from the patient's hospital notes. RESULTS: A total of 191 fractures caused by gunshot were treated in the DRC at the ICRC surgical substitution project during the study period. On average, the fractures were 3 days old on admission and were all open, with 62% also being comminuted. The ICRC management protocol, which emphasizes debridement, antibiotic prophylaxis and conservative fracture stabilization, was followed in all cases. Forty-eight percentage of the fractures were finally classified as 'union without complication'; however, 17% were classified as 'malunion'. CONCLUSIONS: This study indicates that open long-bone fractures that are managed by the ICRC surgical substitution project in DRC may have an increased likelihood of malunion as compared to long-bone fractures treated in developed countries. Patient delay and mechanism of injury may have caused increased rates of infection which are likely behind these increased rates of malunion, alongside the lack of definitive fracture treatment options made available to the surgical team.
INTRODUCTION: Malunion is a well-recognized complication of long-bone fractures which accounts for more than 25% of injuries in conflict zones. The aim of this study was to investigate the rate of malunion sustained by casualties with penetrating gunshot wounds in an International Committee of the Red Cross (ICRC) surgical substitution project in the Democratic Republic of Congo (DRC) and compare these results with current literature. METHODS: A retrospective cohort study was performed. All patients admitted to the ICRC facility between the periods of 01.10.2014 and 31.12.2015 with long-bone fractures caused by gunshot wound were included, and data were collected retrospectively from the patient's hospital notes. RESULTS: A total of 191 fractures caused by gunshot were treated in the DRC at the ICRC surgical substitution project during the study period. On average, the fractures were 3 days old on admission and were all open, with 62% also being comminuted. The ICRC management protocol, which emphasizes debridement, antibiotic prophylaxis and conservative fracture stabilization, was followed in all cases. Forty-eight percentage of the fractures were finally classified as 'union without complication'; however, 17% were classified as 'malunion'. CONCLUSIONS: This study indicates that open long-bone fractures that are managed by the ICRC surgical substitution project in DRC may have an increased likelihood of malunion as compared to long-bone fractures treated in developed countries. Patient delay and mechanism of injury may have caused increased rates of infection which are likely behind these increased rates of malunion, alongside the lack of definitive fracture treatment options made available to the surgical team.
Authors: Hüseyin Arslan; Mehmet Subasi; Cumhur Kesemenli; Ahmet Kapukaya; Serdar Necmioğlu; Cuma Kayikçi Journal: Injury Date: 2002-11 Impact factor: 2.586
Authors: R Hoencamp; E C T H Tan; F Idenburg; A Ramasamy; T van Egmond; L P H Leenen; J F Hamming Journal: Eur J Trauma Emerg Surg Date: 2014-04-15 Impact factor: 3.693
Authors: Ussamah El-Khani; Hutan Ashrafian; Shahnawaz Rasheed; Harald Veen; Ammar Darwish; David Nott; Ara Darzi Journal: BMJ Glob Health Date: 2019-11-14