War wounds with fractures: The ICRC experience

Abstract

Historically, on a conventional battlefield, about 70% of the wounded present injuries to the limbs, the remaining 30% have central wounds involving head, chest or abdomen. The longer the delay in transport to hospital facilities, especially with inadequate first aid, the higher the death rate in the central injury group and the higher the percentage of those presenting with limb injuries. Most of these latter involve bones and/or joints. In a war situation, and especially in developing countries, high-technology facilities and skilled orthopaedic surgeons may not be available to deal with these wounds with particularly heavy tissue contamination. The experience of ICRC surgeons has led to an appropriate technology approach and the avoidance of sophisticated operations and equipment: “the simpler the better” has become our motto! Very important is the initial, extensive excision of all dead and devitalised tissues. The fractured bone is held by POP slabs, bridge POP, skeletal tractions and, in selected cases, external fixation. Internal fixation devices are never used due to the high risk of infection. Early and aggressive physiotherapy is of paramount importance. Good surgery without physiotherapy often results in a human catastrophe.