Early & Definitive Treatment of War Compound Fracture

W. Al-Shahawani, Zaid

	Early & Definitive Treatment of War Compound Fracture
IRAQI JOURNALOF COMMUNITY MEDICINE
Article 1, Volume 25, Issue 4, 2012, Pages 352-356
Author
Zaid W. Al-Shahawani
Abstract
Abstract Background: A good deal of war surgery is orthopedic surgery, (50-75%) of war injuries involve the limbs, that‘s because Soldier’s at war use to be well protected by the armor for the chest & abdomen with a helmet for the head & part of the neck & a well protected vehicles for transport, the only expose part remain of the body are the limbs,, such patient may survive longer than patients with head, chest & abdomen injuries and may present to the hospital even days or weeks after injury with badly infected ,foul smelling wounds, Most of these wounds involve bones and/or joints ,, leading to what is known as open or a compound fracture . Patients & Methods: One hindered and seven cases of war compound fractures were included in this paper, 37 female & 70 male studied from Jan 2006 – Aug.2007 in al-Yermouk teaching hospital. These injuries were caused by shells of a nearby bomb explosion, or a bullet injury from a near distance or a sniper shot due to shells mortar explosion our cases were treated first by early operative debridement for the wounds then bone stabilization for the fractures using different methods for splinting the fractures bone. Result: Cases were divided into many groups according to Castillo classification. As the following; G i ( 20 cases) (18.64 %), G ii (54 cases) (50.46 %), G iii (33 cases) (30.80%), from the 107 cases, 75 cases of Lower limb (70.1%), and 32 cases upper limb forming about (29.90%). Group one castillo G1. Mainly treated by P.O.P. splint (casting slabs) 15 cases … 5 cases (skin traction). Group two Castillo G11; 40 cases (74%) treated by External fixation 14 cases (26%) by internal fixation, 6 cases treated by plat & screw, 5 cases treated by rush nail & 3 cases treated by –K nail. Group three Castillo G111 mainly by external fixation 29 cases, 4 cases internal fixation by locking K- nail. Conclusion: One hindered and seven cases of war compound fractures were treated according to two steps, first by early surgical operative debridement, to do wound excision plus removal of foreign body, dirt, remnant of cloths, shells, and dead soft tissue, then the second steps fixation of fractures using different methods, in our research we found that external fixation is the best & safest methods (used in around 80% of the cases ) to fix such a fractures, or we can used other different methods of fixation according to what is appropriate for each case.

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