External fixation-minimal osteosynthesis: indications, role, and place in war surgery.

This investigation is based on results obtained by means of debridement, drainage, and application of external fixation of war wounds and injuries to the extremities. Injuries were classified by the extent of soft-tissue and bone damage according to the classification scheme of Gustilo et al. (1984). One hundred ninety external fixations in 179 patients were performed and were followed up for 14 to 26 months (mean, 21.7 months). Methodologic complications and results of these cases are presented. Minimal osteosynthesis was used in 93 (48.9%) cases. Within a year after injury, 96% (182 of 190) of the fractures were united; 71% (135 of 190) of the fractures had been treated with external fixation only or with cancellous bone grafting. When outcome after external fixation only is compared with that after external fixation-minimal osteosynthesis, bone union without additional instrumentation occurred in 47.4% (46 of 97) versus 64.5% (60 of 93) of cases (t = 2.372, p < 0.01), and total complication rates were 55.5% (55 of 99) versus 38.1% (37 of 97) of cases (t = 2.332, p < 0.01), respectively. In indicated cases and with a properly performed technique, minimal osteosynthesis in association with external fixation as a first and final treatment method significantly improved outcome, and also reduced the total rate of bone healing complications.