Clasper J C, Rowley D I
Academic Department of Military Surgery, Trauma Frimley Park NHS Foundation Trust, Frimley, UK.
J Bone Joint Surg Br. 2009 Jan;91(1):97-101. doi: 10.1302/0301-620X.91B1.21106.
We reviewed the clinical details and radiographs of 52 patients with ballistic fractures of the femur admitted to the International Committee of the Red Cross Hospital in Kenya (Lopiding), who had sustained injuries in neighbouring Sudan. In all cases there had been a significant delay in the initial surgery (> 24 hours), and all patients were managed without stabilisation of the fracture by internal or external fixation. Of the 52 patients, three required an amputation for persisting infection of the fracture site despite multiple debridements. A further patient was treated by an excision arthroplasty of the hip, but this was carried out at the initial operation as a part of the required debridement. All of the remaining 48 fractures healed. Four patients needed permanent shoe adaptation because of limb shortening of functional significance. Although we do not advocate delaying treatment or using traction instead of internal or external fixation, we have demonstrated that open femoral fractures can heal despite limited resources.
我们回顾了52例股骨弹道骨折患者的临床细节和X光片，这些患者均入住肯尼亚（洛皮丁）红十字国际委员会医院，他们在邻国苏丹受伤。所有病例在初次手术时均有显著延迟（超过24小时），且所有患者均未通过内固定或外固定来稳定骨折。在这52例患者中，3例尽管进行了多次清创，但因骨折部位持续感染而需要截肢。另有1例患者接受了髋关节切除成形术，但这是在初次手术时作为所需清创的一部分进行的。其余48处骨折均愈合。4例患者因具有功能意义的肢体缩短而需要永久调整鞋子。尽管我们不主张延迟治疗或使用牵引而非内固定或外固定，但我们已经证明，尽管资源有限，开放性股骨骨折仍可愈合。
