Fracture union rates across a century of war: a systematic review of the literature

Stewart, Shona; Tenenbaum, O; Higgins, C.; Masouros, Spyros D.; Ramasamy, Arul

doi:10.1136/bmjmilitary-2019-001375

Cited by 5 publications

(4 citation statements)

References 53 publications

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“…The substantial burden of GMR injuries on both patients and the healthcare system in the Gaza Strip is evident. Notably, the patients predominantly consisted of young males, reflecting the demographic profile of those affected by violence-related trauma in conflict zones [ 21 ]. Around 50% of patients sustained Gustilo IIIB open tibial fractures, accompanied with nerve injuries, large skin injuries, and over 1 cm of bone loss, highlighting the severity and complexity of cases and the need for extensive surgical interventions, such as debridement and soft tissue reconstruction [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

The integration of ortho-plastic limb salvage teams in the humanitarian response to violence-related open tibial fractures: evaluating outcomes in the Gaza Strip

Farhat,

Moussally,

Nahouli

et al. 2024

Confl Health

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Background Limb salvage by ortho-plastic teams is the standard protocol for treating open tibial fractures in high-income countries, but there’s limited research on this in conflict settings like the Gaza Strip. This study assessed the clinical impact of gunshot-related open tibial fractures, compared patient management by orthopedic and ortho-plastic teams, and identified the risk factors for bone non-union in this context. Methods A retrospective review of medical records was conducted on Gaza Strip patients with gunshot-induced-open tibial fractures from March 2018 to October 2020. Data included patient demographics, treatments, and outcomes, with at least one year of follow-up. Primary outcomes were union, non-union, infection, and amputation. Results The study included 244 injured individuals, predominantly young adult males (99.2%) with nearly half (48.9%) having Gustilo-Anderson type IIIB fractures and more than half (66.8%) with over 1 cm of bone loss. Most patients required surgery, including rotational flaps and bone grafts with a median of 3 admissions and 9 surgeries. Ortho-plastic teams managed more severe muscle and skin injuries, cases with bone loss > 1 cm, and performed less debridement compared to other groups, though these differences were not statistically significant. Non-union occurred in 53% of the cases, with the ortho-plastic team having the highest rate at 63.6%. Infection rates were high (92.5%), but no significant differences in bone or infection outcomes were observed among the different groups. Logistic regression analysis identified bone loss > 1 cm, vascular injury, and the use of a definitive fixator at the first application as predictors of non-union. Conclusions This study highlights the severity and complexity of such injuries, emphasizing their significant impact on patients and the healthcare system. Ortho-plastic teams appeared to play a crucial role in managing severe cases. However, further research is still needed to enhance our understanding of how to effectively manage these injuries.

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Section: Discussionmentioning

confidence: 99%

The integration of ortho-plastic limb salvage teams in the humanitarian response to violence-related open tibial fractures: evaluating outcomes in the Gaza Strip

Farhat,

Moussally,

Nahouli

et al. 2024

Confl Health

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“…The study has a number of limitations, including the inability to definitively assess union/mal-union at 12 weeks’ follow-up. Some definitions of non-union refer to lack of union of up to six months, or even up to a year [ 33 ]. Additionally, this study was undertaken without a group tested with a comparator device.…”

Section: Discussionmentioning

confidence: 99%

Clinical trial of a low-cost external fixator for global surgery use

Milandri

Wijesinghe

Munidasa

et al. 2023

International Orthopaedics (SICOT)

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Purpose A low-cost modular external fixator for the lower limb has been developed for global surgery use. The purpose of this study is to assess outcome measures in the first clinical use of the device. Methods A prospective cohort study was conducted with patients recruited in two trauma hospitals. Initial clinical procedure data were collected, and patients were followed up every two weeks until 12 weeks or definitive fixation. Follow-up assessed infection, stability, and radiographic outcomes. In addition, patient-reported outcomes and surgeons’ feedback on device usability were collected by questionnaires. Results The external fixator was used on 17 patients. Ten were mono-lateral, five were joint spanning, and two were delta configuration. One patient had a pin site infection at 12-week follow-up. All were stable when tested mechanically and using radiographic assessment, and 53% were converted to definitive fixation. Conclusion The low-cost external fixator developed is appropriate for use in global surgery trauma centres with good clinical outcomes. Prospective trial registration number and date SLCTR/2021/025 (06 Sep 2021).

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“…That way, and because of limited tissue availability for flap coverage, the traditional orthopedic reconstruction techniques had to be optimized to comport with these complex trauma entities. Although the surgical techniques and the equipment evolved, it failed to be depicted in higher union rates, mainly because of the parallel evolvement of weapons and complex injury patterns [25].…”

Section: Bone Reconstructionmentioning

confidence: 99%

Management of War Limb Injuries in the 21st Century

Katsaras

2021

AJMAH

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Background: War trauma includes some of the most complex injury entities that require complex techniques, often in austere settings. After body armor use and advanced resuscitation and evacuation plans, limb injuries and salvage has increased. In this article, we review the recent war injured care, regarding limb injuries. Methods: Retrospective literature search in PubMed was conducted for articles after 2010, regarding initial limb salvage and advanced reconstruction after evacuation. 43 published articles and manuals were included in the review, so that the latest protocols be interpreted. Results: Protocols of war surgery and extremity injuries have changed in modern warfare, as high energy weapons often cause severe limb injuries affecting multiple tissues. Of utmost importance is the thorough debridement and staged reconstruction, after optimization of injured tissue condition. In priority series, vascular, bony, nerve and soft tissue injuries have to be addressed. Reconstruction techniques must be adapted to each injury. Conclusion: As weapons evolve and war conduction changes, medical care must constantly evolve, too, in order to meet the standard of care required to achieve extremity salvage and good functionality.

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Fracture union rates across a century of war: a systematic review of the literature

Cited by 5 publications

References 53 publications

The integration of ortho-plastic limb salvage teams in the humanitarian response to violence-related open tibial fractures: evaluating outcomes in the Gaza Strip

The integration of ortho-plastic limb salvage teams in the humanitarian response to violence-related open tibial fractures: evaluating outcomes in the Gaza Strip

Clinical trial of a low-cost external fixator for global surgery use

Management of War Limb Injuries in the 21st Century

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