Forward Surgical Stabilization of Penetrating Lower Extremity Fractures: Circular Casting Versus External Fixation

McHenry, Timothy; Simmons, S. W.; Alitz, Curt; Holcomb, John B.

doi:10.1093/milmed/166.9.791

Cited by 15 publications

(6 citation statements)

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“…External fixation has even been recommended on logistic rather than medical reasons (8). This prospective study reports a very high early complication rate of external fixation and cautions against its universal acceptance.…”

Section: Introductionmentioning

confidence: 81%

“…The use of an external fixator for managing war wounds has been debated, with opinions both for and against its use (4)(5)(6)(7)(8)(9)(10). At the end of the Second World War, Cleveland in a post war summary reported that it was associated with a very high complication rate, and the devices were removed from American military hospitals (4).…”

Section: Introductionmentioning

confidence: 99%

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Early Failure Of External Fixation In The Management Of War Injuries

Clasper¹,

Phillips²

2005

J R Army Med Corps

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Objective To review external fixation in the management of war injuries. Method We prospectively followed up 15 external fixators (14 patients) applied in the management of war injuries. All these patients were treated at 202 Field Hospital during the 2003 Gulf Conflict. Results Of the 15 fixators, 13 (86.7%) required early revision or removal due to complications of the injury or the fixator. Instability was a problem with 10 fixators (67%), pin loosening was noted with 5 fixators (33%) involving twelve pins, and a significant pin track infection developed at 14 pin sites (3 fixators – 20%), which failed to resolve despite intravenous antibiotics. Conclusions This study demonstrates a very high early complication rate of external fixation in the management of military injuries and cautions against its universal acceptance. If used, consideration must be given to the optimum time of frame application, whether at the time of initial debridement or at a later operation, and the optimal frame design, which will depend on the specific bone and fracture pattern. Pin site care must also be considered, particularly with the restrictions imposed by the military environ-ment.

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Section: Introductionmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Early Failure Of External Fixation In The Management Of War Injuries

Clasper¹,

Phillips²

2005

J R Army Med Corps

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“…However, in a post war report, Cleveland stated that "its use was associated with a high percentage of both infection and delayed union ... the method was therefore forbidden and removed from the hospitals..." [58]. More recently, based upon an analysis of the conflict in Somalia, external fixation became the preferred stabilization method for US forces [59]. The advantages of external fixation include facilitation of transportation of wounded patients with fractured extremities, allowing access to soft tissue wounds and thereby enabling effective wound care, and rapid stabilisation of the skeletal system to permit revascularisation procedures.…”

Section: Management Of Skeletal Injurymentioning

confidence: 99%

Improvised Explosive Devices: Pathophysiology, Injury Profiles and Current Medical Management

Ramasamy

Hill

Clasper³

2009

J R Army Med Corps

149

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The improvised explosive device (IED), in all its forms, has become the most significant threat to troops operating in Afghanistan and Iraq. These devices range from rudimentary home made explosives to sophisticated weapon systems containing high-grade explosives. Within this broad definition they may be classified as roadside explosives and blast mines, explosive formed pojectile (EFP) devices and suicide bombings. Each of these groups causeinjury through a number of different mechanisms and can result in vastly different injury profiles. The "Global War on Terror" has meant that incidents which were previously exclusively seen in conflict areas, can occur anywhere, and clinicians who are involved in emergency trauma care may be required to manage casualties from similar terrorist attacks. An understanding of the types of devices and their pathophysiological effects is necessary to allow proper planning of mass casualty events and to allow appropriate management of the complex poly-trauma casualties they invariably cause. The aim of this review article is to firstly describe the physics and injury profile from these different devices and secondly to present the current clinical evidence that underpins their medical management.

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“…The current literature suggests that the favored tool for DCO in lower limbs is the application of external fixators. External fixations provide the advantages of decreased operating time, decreased blood loss and does not increase local complications besides not impairing the quality of definite osteosynthesis [20]. There are many types of extemal fixators, but the AD type tubular fixator is the commonest and most user friendly.…”

Section: Fracture Fixation : Damage Control Orthopedicsmentioning

confidence: 99%

Extremity and Orthopaedic Injuries

Anand

2010

Medical Journal Armed Forces India

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The extremities remain the most common sites of wounding in combat, and are often a combination of injures to soft tissues, bones, vessels and nerves. While these injuries are managed only after life threatening injuries are tackled first, precise evaluation and prompt management strategies to attain optimal outcome remain the goals of treatment. With advancements in tourniquet science, broader spectrum antibiotics, use of negative pressure wound therapy, easier options for fracture stabilization and continuously evolving reconstructive procedures have all increased the tools available to the surgeon to salvage severely damaged limbs.

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Forward Surgical Stabilization of Penetrating Lower Extremity Fractures: Circular Casting Versus External Fixation

Abstract: Based on these variables, the authors determined that external fixation is the treatment of choice for penetrating lower extremity fractures in the forward surgical environment.

Cited by 15 publications

References 0 publications

Early Failure Of External Fixation In The Management Of War Injuries

Early Failure Of External Fixation In The Management Of War Injuries

Improvised Explosive Devices: Pathophysiology, Injury Profiles and Current Medical Management

Extremity and Orthopaedic Injuries

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