There was no statistically significant difference in clinical and functional results between the groups. We suggest that both methods are comparable.

Infections caused by Mycobacterium setense or Clostridium celerecrescens are extremely rare. In this report, for the first time a dual infection with these two pathogens is described. An 18-year-old female suffered multiple injuries, including an open comminuted fracture of the right humeral diaphysis after falling from a fifth-floor balcony in January 2019. Five months after the accident, a fistula appeared in the scar, reaching the bone tissue. M. setense and C. celerecrescens were cultured from sinus swabs and subsequently from perioperative samples. The patient was initially treated with a combination of intravenous antibiotics (ATBs): imipenem, amikacin, and ciprofloxacin. One month after the fracture fixation with a titanium nail, C. celerecrescens was again detected; therefore, metronidazole was added to the therapy. A triple combination of oral (PO) ATBs (trimethoprim–sulfamethoxazole, moxifloxacin, and metronidazole) followed, 8 weeks after the initial intravenous therapy. C. celerecrescens was cultured again two times, most recently in November 2019, when surgical debridement was supplemented by the topical administration of cancellous bone impregnated with vancomycin. Signs of bone healing were found at follow-ups and ATB treatment was finished in March 2020 after a total of 9 months of therapy. To this day, there have been no signs of reinfection. This case thus illustrates the need for a combination of systemic and individualized local therapy in the treatment of complicated cases of dual infections with rare pathogens.

We must be prepared for a survivorship of about 600 to 700 injured passengers in case of an accident involving two jumbo jets as these planes are able to absorb more impact forces than earlier types, and 40%-50% of the passengers may survive.A triage post, an anteroom for resuscitation and anesthesia, and an operating room with 3 tables must be installed within the airport. Mobile operation units are necessary in addition for urgent surgical care on the spot. The optimum time of the operational readiness is approximately half an hour, if “on the spot surgical care” is to be effective.At the triage post several tables are available, each with an experienced surgeon for the rapid medical examination. The time of examination and triage for each victim of the earthquake disaster in El Asnam was three minutes.In an airport disaster, about 10% of survivors might belong to the first category of triage, i.e., have life-threatening injuries. They will require resuscitation and urgent surgical care. Twenty percent might be seriously wounded passengers of the second category, who should be conveyed to hospital as soon as possible. Seventy percent might have minor injuries of the third category and can wait for care and transportation.Many victims may require neurosurgical operations, but this should be carried out by trained experts and not at the airport. Open depressed skull fractures should be treated at the airport by shaving the scalp, irrigating the wound, applying a sterile dressing and instituting antibiotic therapy. Foreign bodies should be left in place until definitive surgery can be undertaken.