Particularities of the therapeutic procedures and success in treatment of combat-related lower extremities injuries

Abstract

Background/Aim. In a combat environment the extremities continue to be the most common sites of injury with associated high rates of infectious complications due to initial contamination. The aim of this observational study was to determine therapeutic procedures effective in a combat environment and to assess functional outcomes of definitive care. Methods. A total of 44 casualties with combat-related lower extremities fractures sustained during combat operations in former Yugoslavia in a 2-year period (1993-1994) were enrolled. Initial management of these injuries was performed at battlefield (echelon I), surgical treatment was provided in the hospital in Trebinje (echelon II) and definitive care was provided in the Orthopedic Ward of General Hospital in Niksic (echelon III). Results. All combat casualties received surgical treatment within 6-48 hours. Antibiotics were administered during hospitalization in 37 (84%) of all the patients. In all the cases fractures healed, while 15 (38.59%) of them developed complications (most notably osteomyelitis in 3 of the cases, dysfunction in adjacent joints in 3 of the cases and infection of the soft tissue around pins in 3 of the cases). Follow-up period was a little bit over 2 years and reliable conclusions regarding the therapy and the outcomes could be made. Good functional outcomes were prevalent (63.63%), satisfactory were present in one fifth and inadequate in 13.63% of all the cases. There were no amputations or fatalities. Internal fixation was shown to be the method of definitive surgical care of combat-related lower extremity fractures. Conclusion. The management of combat- related lower extremity fractures is complex, multidisciplinary approach through echelons is necessary and internal fixation as the method of definitive surgical care is essential.