Possley Daniel R, Burns Travis C, Stinner Daniel J, Murray Clinton K, Wenke Joseph C, Hsu Joseph R
United States Army Institute of Surgical Research, Fort Sam Houston, Texas 78234-6315, USA.
J Trauma. 2010 Jul;69 Suppl 1:S135-9. doi: 10.1097/TA.0b013e3181e44fcb.
External fixation has been used extensively during recent wars as a damage control measure for fractures in coalition forces being evacuated. We hypothesize that external fixation is a safe and effective initial stabilization procedure for combat-related open fractures.
Records on 55 consecutive type III tibia fractures between March 2003 and September 2007 were reviewed. We stratified the complications related to external fixation as major, potential, and minor complications. We defined major complications as neurovascular injury, mechanical failure, septic joint, and pin tract osteomyelitis. Potential complications were defined as pins within 1 inch of the fracture, pin overpenetration (> or = 26 mm), pin without cortical purchase, and intracapsular pin placement. Minor complications were defined as pin tract infections, addition of pins or bars, and pin overpenetration (9-25 mm). "Successful application" was defined as the absence of major or potential complications.
We recorded no major complications. There were 12 of 53 (22.6%) constructs and 21 of 228 (9.2%) pins inserted with potential complications. We detected minor complications in 27 of 53 (50.9%) constructs and 35 of 228 (15.3%) pins inserted; 41 of 53 (77.4%) constructs had no major or potential complications.
Treatment of combat-related open tibia fractures with external fixation was 77% successful in our series. We recorded no major complications but demonstrated the possibility for technical improvement in one of the five constructs with potential complications. Despite the recorded potential and minor complications, external fixation is safe and effective as a temporary damage control in open fractures sustained in combat.
在最近的战争中，外固定术作为联军撤离时骨折的损伤控制措施被广泛应用。我们假设外固定术是治疗与战斗相关的开放性骨折的一种安全有效的初始稳定方法。
回顾了2003年3月至2007年9月间连续55例Ⅲ型胫骨骨折的记录。我们将与外固定相关的并发症分为严重、潜在和轻微并发症。我们将严重并发症定义为神经血管损伤、机械故障、化脓性关节和针道骨髓炎。潜在并发症定义为针位于骨折部位1英寸范围内、针过度穿透（≥26毫米）、针未穿透皮质以及针位于关节囊内。轻微并发症定义为针道感染、增加针或连接杆以及针过度穿透（9 - 至25毫米）。“成功应用”定义为无严重或潜在并发症。
我们未记录到严重并发症。53例固定装置中有12例（22.6%）以及228根针中有21根（9.2%）存在潜在并发症。我们在53例固定装置中有27例（50.9%）以及228根针中有35根（15.3%）检测到轻微并发症；53例固定装置中有41例（77.4%）无严重或潜在并发症。
在我们的系列研究中，采用外固定术治疗与战斗相关的开放性胫骨骨折成功率为77%。我们未记录到严重并发症，但在存在潜在并发症的五个固定装置中的一个显示出技术改进的可能性。尽管记录到了潜在和轻微并发症，但外固定术作为战斗中开放性骨折的临时损伤控制方法是安全有效的。
