Neglected patella non-unions are rare. Contraction of the quadriceps makes late repair extremely difficult. A case of distal patella pole fracture neglected for 8 years is presented. The patient was a hemiplegic young female unable to walk due to extensor mechanism deficiency with a 10 cm retraction of the patella proximal pole at her neurologically intact side. The quadriceps was lengthened using a spanning unilateral external fixation system and the fragments successfully united after trans-osseous suture repair. At 4-year follow-up the patient was independently ambulating without symptoms with a functional knee range of motion. Level of evidence IV.

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Background and Aim:There are a lot of unique challenges for the military medical personnel assigned to Afghanistan. We evaluate the results of the co-operation between a German and a Greek surgical team during a 3-month period in a role II hospital.Materials and Methods:Patients who were admitted to the role II German hospital of Kunduz were evaluated. We reviewed the type of diseases, mechanism and location of injuries, management, types of surgical procedures, blood supply, and outcome.Results:The data included 792 ISAF patients, 18 NGOs patients, and 296 local patients. Out of them, 71.6% of the patients were ISAF personnel; 51 patients underwent a surgical operation; 35 of them were operated in an emergency base. Fifty-five surgical procedures were performed. In 22 (43.1%) of these patients, orthopedic procedures were performed, while in the rest 29 (56.9%) patients the operations were of general surgery interest. Gunshot injuries were the main mechanism of injury for locals, whereas ISAF personnel were usually presented with injuries after IEDs and rocket attacks. A total number of 11 patients were transferred to role III military hospitals for further treatment within 24 hours.Conclusions:The co-operation between surgical teams from different countries, when appropriately trained, staffed, and equipped, can be highly effective in a combat environment.

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