Department of Orthopedics and Traumatology, Faculty of Medicine, Namık Kemal University, Tekirdağ, Turkey.
Istanbul Hand Surgery and Microsurgery Group, Yeni Yüzyıl University, Hand and Upper Extremity Surgery Unit, Gaziosmanpaşa Private Hospital, Nisantasi University Vocational High School, Istanbul, Turkey.
Injury. 2020 Nov;51(11):2601-2611. doi: 10.1016/j.injury.2020.08.028. Epub 2020 Aug 24.
In this study, we aimed to describe the relationship between the localization of rarely seen upper extremity war injuries and their complications in the subacute period, and define our preferences for surgery and antibiotic use.
Patients with an upper extremity war injury who presented to our institution between 2015 and 2018 were retrospectively evaluated. Data regarding demographics, time between injury and presentation, location of injury, type of damage, complications, treatment methods, infection rates and antibiotic use were recorded. Tissue defects, fracture fixation, neurovascular damage, infection development and treatment approaches were analyzed.
Sixty-two male patients with isolated upper extremity injuries (mean age: 31.66 ± 8.28 years) were included in the study. The average time between trauma and hospitalization was 14 days. The mean hematocrit (Hct) level at presentation was 36.3 ± 6.8%. Patients had been followed up for an average period of 95.6 ± 32.1 days. Twenty-nine patients (46.8%) had nerve injury, eight (12.9%) had arterial injury that required repair, and 23 had infection (37.1%), of which five developed osteomyelitis. Infection was polymicrobial in nine cases and monobacterial in 14. A positive correlation was found between the presence of fracture and nerve injury (p = 0.013). The frequency of nerve injuries due to gunshot wounds was higher in the mid-section and lower part of the arms and in the proximal forearm when compared to other regions (p = 0.011). The infection rates were significantly higher in patients with fractures (p = 0.033). The mean hematocrit (Hct) level at presentation of the patients with infection (32.1 ± 6.3%) was significantly lower than that of those who did not have infection (38.8 ± 5.9%) (p<0.001).
Upper extremity war injuries require case-specific solutions. Microbiological samples should be taken prior to empirical antibiotic treatment for infection management and rational antibiotic use principles should be applied according to the culture and antibiogram results. The holistic and ambiguous character of nerve injuries often requires early exploration and combined reconstructive interventions. Arterial injuries can be overlooked by physical examination alone and thus routine angiography should be performed. Completion of the bone and soft tissue reconstructions in the same session using a holistic approach minimizes the possible risks.
本研究旨在描述少见上肢战伤的定位与亚急性期并发症之间的关系，并确定我们在手术和抗生素使用方面的偏好。
回顾性分析 2015 年至 2018 年期间我院收治的上肢战伤患者。记录患者的人口统计学资料、受伤至就诊时间、损伤部位、损伤类型、并发症、治疗方法、感染率和抗生素使用情况。分析组织缺损、骨折固定、神经血管损伤、感染发展和治疗方法。
本研究纳入 62 例单纯上肢损伤男性患者（平均年龄：31.66±8.28 岁）。创伤至住院的平均时间为 14 天。就诊时平均血细胞比容（Hct）水平为 36.3±6.8%。患者平均随访 95.6±32.1 天。29 例（46.8%）患者有神经损伤，8 例（12.9%）患者有需要修复的动脉损伤，23 例（37.1%）有感染，其中 5 例发生骨髓炎。9 例感染为混合感染，14 例为单一致病菌感染。骨折与神经损伤之间存在正相关（p=0.013）。与其他部位相比，手臂中段和下段以及前臂近端的火器伤导致神经损伤的频率更高（p=0.011）。骨折患者的感染率明显高于无骨折患者（p=0.033）。有感染的患者就诊时的平均血细胞比容（Hct）水平（32.1±6.3%）明显低于无感染的患者（38.8±5.9%）（p<0.001）。
上肢战伤需要具体情况具体分析。感染管理应在经验性抗生素治疗前进行微生物样本采集，并根据培养和药敏结果应用合理的抗生素使用原则。神经损伤的整体和模糊特征往往需要早期探查和联合重建干预。动脉损伤仅通过体格检查可能会被忽视，因此应常规进行血管造影。采用整体方法在同一时间段完成骨和软组织重建可最大限度降低可能的风险。
