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Reconstruction of nonunion tibial fractures in war-wounded Iraqi civilians, 2006-2008: better late than never.

Abstract：

OBJECTIVE:To describe medical care and surgical outcome after functional reconstructive surgery in late-presenting patients who already had at least one prior operation. DESIGN:Retrospective review of medical care and surgical outcome from August 2006 to December 2008 using patient records for initial data with active follow-up for the latest outcome information. SETTING:Médecins sans Frontières surgical programme in Jordan Red Crescent Hospital, Amman, Jordan. PATIENTS:Sixty-two civilians with nonunion tibial fractures caused by war-related trauma in Iraq; 53 completed follow-up. INTERVENTION:Amputation and/or reconstruction. MAIN OUTCOME MEASUREMENTS:Late surgical complications (after the patient's return to Iraq) were analyzed for infection recurrence, bone union, and functional condition (defined using the Short Musculoskeletal Functional Assessment score). RESULTS:Almost three fourths of patients arrived with infected injuries, 9 of whom had amputation as the initial surgery; the rest, and all uninfected patients, had reconstruction. Excluding loss to follow-up, only 4 of 53 (8%) patients who arrived with an infected injury had infection recurrence. Excluding loss to follow-up and amputation, 2 of 14 (14%) patients in the uninfected and 5 of 30 (17%) in the infected injury group did not achieve successful tibial union. Mean Dysfunctional and Bothersome Indices overall were 27.1 and 29.8, respectively, with similar results for all 3 groups (amputations, uninfected, and infected injuries). CONCLUSIONS:Our study shows that patients with infected and uninfected injuries surgically treated in Amman achieved similar outcomes. Despite late presentation, our patients had a comparable outcome to other studies dealing with early reconstruction. Reconstruction for the infected group required longer treatment time. LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

journal_name

J Orthop Trauma

journal_title

Journal of orthopaedic trauma

authors

Fakri RM,Al Ani AM,Rose AM,Alras MS,Daumas L,Baron E,Khaddaj S,Hérard P

doi

10.1097/BOT.0b013e318225e8d0

subject

Has Abstract

pub_date

2012-07-01 00:00:00

pages

e76-82

issue

eissn

0890-5339

issn

1531-2291

journal_volume

pub_type

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Reconstruction of nonunion tibial fractures in war-wounded Iraqi civilians, 2006-2008: better late than never.