Service de chirurgie orthopédique et traumatologique, hôpital Avicenne, 93000 Bobigny, France.
Orthop Traumatol Surg Res. 2013 Dec;99(8):953-8. doi: 10.1016/j.otsr.2013.08.005. Epub 2013 Oct 23.
The management of ballistic fractures, which are open fractures, has often been studied in wartime and has benefited from the principles of military surgery with debridement and lavage, and the use of external fixation for bone stabilization.
In civilian practice, bone stabilization of these fractures is different and is not performed by external fixation.
Fifteen civilian ballistic fractures, Gustilo II or IIIa, two associated with nerve damage and none with vascular damage, were reviewed. After debridement and lavage, ten internal fixations and five conservative treatments were used.
No superficial or deep surgical site infection was noted. Fourteen of the 15 fractures (93%) healed without reoperation. Eleven of the 15 patients (73%) regained normal function.
Ballistic fractures have a bad reputation due to their many complications, including infections. In civilian practice, the use of internal fixation is not responsible for excessive morbidity, provided debridement and lavage are performed. Civilian ballistic fractures, when they are caused by low-velocity firearms, differ from military ballistic fractures. Although the principle of surgical debridement and lavage remains the same, bone stabilization is different and is similar to conventional open fractures.
开放性骨折（弹道骨折）的治疗方法通常在战时进行研究，并受益于清创和冲洗的军事外科学原则，以及使用外固定器进行骨稳定。
在民用实践中，这些骨折的骨稳定方法不同，不采用外固定器。
回顾了 15 例民用弹道骨折，Gustilo II 或 IIIa 型，其中 2 例合并神经损伤，无血管损伤。清创和冲洗后，采用 10 例内固定和 5 例保守治疗。
无浅表或深部手术部位感染。15 例骨折中有 14 例（93%）未经再次手术愈合。15 例患者中有 11 例（73%）恢复正常功能。
由于感染等多种并发症，弹道骨折的预后较差。在民用实践中，只要进行清创和冲洗，内固定的使用并不会导致过高的发病率。当民用弹道骨折是由低速火器引起时，与军用弹道骨折不同。尽管外科清创和冲洗的原则相同，但骨稳定方法不同，类似于常规开放性骨折。
