Has B, Jovanovic S, Wertheimer B, Mikolasević I, Grdic P
Orthopaedic Department, Clinical Hospital Osijek, Croatia.
Injury. 1995 May;26(4):245-8. doi: 10.1016/0020-1383(95)90010-u.
This paper analyses the medical records of 5024 injured persons treated and operated on at the Surgical Clinic of the Clinical Hospital in Osijek, during the war against Croatia (1991 and 1992). There were 1653 (33.0 per cent) admitted, while the rest were treated as out-patients. Of the admitted patients 82.7 per cent (1372) had limb injuries. In 760 (15.0 per cent) of the wounded, 1320 limb fractures caused by explosives were diagnosed, out of which 856 were of the lower and 464 of the upper limbs. One hundred and ninety-two (3.9 per cent) were treated by external fixation. External fixators were applied to 147 lower and 68 upper open long bones, respectively. Adequate reconstructive operations were performed on 106 (2.1 per cent) patients with associated injuries to important blood vessels. The stabilization of the open and unstable external fractures was achieved by external fixation, mostly at one level, regardless of the wound size. The importance of good wound cleaning has been particularly stressed as well as bone fragment reposition. Special attention has been given to the preoperative and intra-operative assessment of the limbs. In 20 patients (9.3 per cent) treated with external fixation, osteitis occurred. Twenty-one more patients (9.7 per cent), because of bad fracture healing after external fixation, were submitted to secondary internal bone fixation combined with bone grafts. Out of these, nine (42.8 per cent) developed osteitis as a consequence of the additional treatment.
本文分析了在与克罗地亚的战争期间（1991年和1992年）在奥西耶克临床医院外科诊所接受治疗和手术的5024名伤者的病历。其中1653人（33.0%）住院，其余为门诊治疗。在住院患者中，82.7%（1372人）有肢体损伤。在760名（15.0%）伤员中，诊断出1320处由爆炸物导致的肢体骨折，其中856处为下肢骨折，464处为上肢骨折。192人（3.9%）接受了外固定治疗。外固定器分别应用于147根下肢和68根上肢开放性长骨。对106名（2.1%）伴有重要血管损伤的患者进行了充分的重建手术。开放性和不稳定型外骨折通过外固定实现稳定，多数为单平面固定，与伤口大小无关。特别强调了良好的伤口清创以及骨碎片复位的重要性。对肢体的术前和术中评估给予了特别关注。在接受外固定治疗的20名患者（9.3%）中发生了骨炎。另外21名患者（9.7%）由于外固定后骨折愈合不良，接受了二期内固定联合植骨手术。其中，9名（42.8%）患者因额外治疗而发生了骨炎。
