Bauhahn Grace, Veen Harald, Hoencamp Rigo, Olim Nelson, Tan Edward C T H
International Committee of the Red Cross, Geneva, Switzerland.
Ministry of Defence, Department of Surgery, Alrijne Medical Centre Leiderdorp, Leiden University Medical Centre, Leiden, The Netherlands.
World J Surg. 2017 Sep;41(9):2200-2206. doi: 10.1007/s00268-017-4008-5.
Malunion is a well-recognized complication of long-bone fractures which accounts for more than 25% of injuries in conflict zones. The aim of this study was to investigate the rate of malunion sustained by casualties with penetrating gunshot wounds in an International Committee of the Red Cross (ICRC) surgical substitution project in the Democratic Republic of Congo (DRC) and compare these results with current literature.
A retrospective cohort study was performed. All patients admitted to the ICRC facility between the periods of 01.10.2014 and 31.12.2015 with long-bone fractures caused by gunshot wound were included, and data were collected retrospectively from the patient's hospital notes.
A total of 191 fractures caused by gunshot were treated in the DRC at the ICRC surgical substitution project during the study period. On average, the fractures were 3 days old on admission and were all open, with 62% also being comminuted. The ICRC management protocol, which emphasizes debridement, antibiotic prophylaxis and conservative fracture stabilization, was followed in all cases. Forty-eight percentage of the fractures were finally classified as 'union without complication'; however, 17% were classified as 'malunion'.
This study indicates that open long-bone fractures that are managed by the ICRC surgical substitution project in DRC may have an increased likelihood of malunion as compared to long-bone fractures treated in developed countries. Patient delay and mechanism of injury may have caused increased rates of infection which are likely behind these increased rates of malunion, alongside the lack of definitive fracture treatment options made available to the surgical team.
骨折畸形愈合是长骨骨折一种广为人知的并发症，在冲突地区超过25%的损伤中都会出现。本研究的目的是调查在刚果民主共和国红十字国际委员会（ICRC）外科替代项目中，穿透性枪伤伤员的骨折畸形愈合发生率，并将这些结果与现有文献进行比较。
进行了一项回顾性队列研究。纳入2014年10月1日至2015年12月31日期间因枪伤导致长骨骨折而入住ICRC医疗机构的所有患者，并从患者的医院病历中回顾性收集数据。
在研究期间，刚果民主共和国的ICRC外科替代项目共治疗了191例枪伤所致骨折。平均而言，骨折在入院时已发生3天，均为开放性骨折，其中62%为粉碎性骨折。所有病例均遵循ICRC的管理方案，该方案强调清创、抗生素预防和保守骨折固定。最终，48%的骨折被归类为“无并发症愈合”；然而，17%被归类为“畸形愈合”。
本研究表明，与发达国家治疗的长骨骨折相比，刚果民主共和国ICRC外科替代项目处理的开放性长骨骨折可能有更高的畸形愈合可能性。患者延误和损伤机制可能导致感染率增加，这可能是畸形愈合率增加的原因，同时外科团队也缺乏明确的骨折治疗选择。
