ACTA FAC MED NAISS 2011;28(4):225-233

Original article

UDC:616.71-001.5-089.21/.22

Importance of External Fixation in Primary Treatment of War Wounds to the Extremities

Predrag Grubor¹, Milan Grubor², Ivan Golubović¹, Predrag Stojiljković¹, Zoran Golubović^1,3

¹Orthopaedics and Traumatology Clinic Banja Luka, Republic of Srpska, Bosnia and Herzegovina

²School of Medicine Banja Luka, Republic of Srpska, Bosnia and Herzegovina

³University of Niš, Faculty of Medicine, Serbia


summary

A war wound is damage to the body having great kinetic energy, inflicted by firearms, (blast, projectile, burn) and sustained in wartime. It is characterised by massive destruction, primary contamination and modified reactivity of the body. The aim of this retrospective study was to show how to primarily treat the injured extremities, with and without fractures, as well as how to select the method for stabilizing fractured bones. The study involved 2.462 wounded persons. They sustained injuries to the extremities, abdomen, thorax and head, and, having sustained the wounds, they received primary surgical treatment at the Orthopaedics and Traumatology Clinic in Banja Luka in the period between September 15, 1991 and December 1, 1995. Out of the 2.462 wounded subjects, 122 (4.59%) were women, 24 (0.9%) were children and 2.269 (94.15%) were men. The average age of the wounded was 33.73 years. Two hundred sixty-five (10.77%) subjects sustained muscular and cutaneous injuries to the extremities, without bone fractures, and 2.197 (89.23%) wounded persons had broken bone fragments that required stabilisation after the primary surgical treatment. Out of the 2.197 wounded persons with broken bones, 2.043 (92.43%) sustained cumminuted fractures with or without bone defects. In 1.573 (72%) cases, broken bone fragments were primarily stabilized using external fixators, in 531(24%) cases plaster cast and plaster cast in combination with Steinmann pins and Kirschner needles, and in 91(4%) cases we used extension. The most commonly encountered complications with external fixators use were as follows: 86 (5.46%) pin tract infections, 3 (0.19%) pin breakages, 42 (2.66%) fixator reassembly procedures due to inadequate primary placement of the external fixator, 6 (0.38%) iatrogenic vascular lesions inflicted with the drill or pin and 4 (0.25%) iatrogenic nerve lesions. The complexity, specific nature and originality of every war wound require expertise, experience, attention and diligence. Every patient is a separate entity and they require an active attitude throughout the course of treatment. The experiences gained in the last war (working with 28 types of external fixators) and the results obtained give me the right to maintain that the method of choice for primary stabilisation of bone fragments in war wounds is Mitković’s external fixation type M20.

Key words: External fixation is Mitković’s type M20