Zeljko Busić, Lovrć Zvonimir, Amć Enio, Busić Vlatka, Lovrć Ljiljana, Markovć Ivan
Department of Surgery, University Hospital Dubrava Zagreb, Zagreb, Croatia.
Mil Med. 2006 Jan;171(1):55-7.
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.
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.
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.
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.
现代战争中超过75%的损伤为四肢损伤，通常伤口污染严重且伴有大面积软组织破坏。在本综述中，我们呈现了41例四肢开放性骨折单发战伤患者中35例的远期功能结果。
在1991年8月至1992年2月的6个月期间，在新格拉迪什卡综合医院（克罗地亚新格拉迪什卡）共治疗了1050例受伤患者，其中49例为四肢孤立性开放性骨折患者。平均年龄为34岁（范围17 - 85岁）；44例受伤患者（90%）为男性，37例（76%）为士兵。49例受伤患者中有8例（16%）接受了一期截肢，27例受伤患者（66%）进行了外固定；8例受伤患者（19.5%）接受了一期内固定。12年后，35例（85%）受伤患者可就以下方面进行评估：（a）骨折不愈合，（b）骨髓炎，（c）晚期截肢，（d）神经麻痹，以及（e）功能。
5例患者（12%）发生骨髓炎，仅1例为一期外固定患者。在2例外固定延期转换为内固定的病例中发生了骨髓炎，需要重新应用外固定架。在过去5年中骨髓炎无复发，12年后，超过四分之三的受伤患者相关近端和远端关节功能无减退或仅有轻度减退。根据日常生活活动独立指数评分，仅2例受伤患者为B级，其余为A级。
外固定是治疗与战争相关的四肢开放性骨折的首选和决定性治疗方法，可产生良好的远期功能结果。外固定转换为内固定会导致骨髓炎，需要再次手术并应用二期外固定。
