Clasper J C, Phillips S L
J R Army Med Corps. 2005 Jun;151(2):81-6. doi: 10.1136/jramc-151-02-04.
To review external fixation in the management of war injuries.
We prospectively followed up 15 external fixators (14 patients) applied in the management of war injuries. All these patients were treated at 202 Field Hospital during the 2003 Gulf Conflict.
Of the 15 fixators, 13 (86.7%) required early revision or removal due to complications of the injury or the fixator. Instability was a problem with 10 fixators (67%), pin loosening was noted with 5 fixators (33%) involving twelve pins, and a significant pin track infection developed at 14 pin sites (3 fixators - 20%), which failed to resolve despite intravenous antibiotics.
This study demonstrates a very high early complication rate of external fixation in the management of military injuries and cautions against its universal acceptance. If used, consideration must be given to the optimum time of frame application, whether at the time of initial debridement or at a later operation, and the optimal frame design, which will depend on the specific bone and fracture pattern. Pin site care must also be considered, particularly with the restrictions imposed by the military environment.
回顾外固定在战伤治疗中的应用。
我们前瞻性地随访了15例用于战伤治疗的外固定器（14例患者）。所有这些患者均于2003年海湾冲突期间在202野战医院接受治疗。
在15例固定器中，13例（86.7%）因损伤或固定器并发症需要早期翻修或取出。10例固定器（67%）存在稳定性问题，5例固定器（33%）出现钢针松动，涉及12根钢针，14个针道（3例固定器，20%）发生严重针道感染，尽管静脉使用抗生素仍未缓解。
本研究表明，外固定在军事创伤治疗中的早期并发症发生率非常高，因此不建议普遍采用。如果使用外固定，必须考虑最佳的固定架应用时间，无论是在初次清创时还是在后期手术时，以及最佳的固定架设计，这将取决于具体的骨骼和骨折类型。还必须考虑针道护理，特别是在军事环境的限制条件下。
