Aim and methods: We present our results on the treatment an outcome of femoral non-unions in our institution as tertiary referral centre. Retrospective analysis was performed using the ASAMI criteria.

Results: 19 patients, 12 men and 7 women were retrospectively assessed. Mean age was 40 years (range 17–72). 11 fractures were in the diaphysiseal area and 8 were in the supracondylar area. 5 cases were infected non-unions. Time from fracture to definitive treatment varied from 5 to 88 months (mean 21 months).

Open technique was used in 18 cases. In 8 cases we have used autogenous cancellous bone graft and in 3 cases BMP7 was used in addition to bone graft. 9 cases were treated with Ilizarov frame without bone graft, 6 with plate and bone graft, 3 with intramedullary nail and 1 with bone graft alone. Internal bone transport was carried out in 5 cases to achieve limb length equality.

Fracture union was achieved in 16 patients with 7 excellent and 8 good results as per ASAMI criteria. 15 cases achieved excellent to good functional results. Because of persistent infection, 2 distal femoral non-unions required transfemoral amputation. Treatment was discontinued due to psychiatric illness in 1 patient with Ilizarov frame. Two of the patients in supracondylar group developed knee stiffness. Pin tract infection is a common complication in Ilizarov group.

Conclusion: Adequate reduction and stabilization is key to success. Non-unions without any complications can be treated with exchange nail or open reduction and plating. Ilizarov method is effective for non-unions complicated by distal location, infection and bone loss. Psychological assessment is important before considering Ilizarov method of treatment.

Introduction: Children are inevitably casualties in wars. They are treated variously by local doctors and foreign surgeons working for military and Non-Governmental Organisations. The basic principles of surgical treatment of war wounds are the same as for adults, but there are specific differences in injury pattern and the response to injury that must be borne in mind.

Method: Casualties under sixteen years age with extremity trauma caused by missiles or blast admitted to a British military field hospital during the latest Gulf War were evaluated. The date, time and method of wounding were recorded and ICRC Wound Scores calculated. The details of surgical treatment prior to admission, and further surgical management described. Case studies were used to illustrate particular considerations relevant to paediatric trauma.

Results: The records for sixteen wounded children were available for analysis. Their ages ranged from three to fifteen years. The method of injury falls into three phases, gun-shot wounds during the mobile attack, shell fragment wounds during the seige of urban areas and blast/fragment injuries from small munitions from the period following active fighting. Blast/fragment wounds typically affected multiple body areas.

Half the patients had received surgical treatment before reaching the hospital, either at civilian hospitals, forward military surgical units or both. None of this surgery was strictly “life or limb-saving”. Amputations performed prior to admission were in the proximal tibia and followed the long posterior flap pattern appropriate to an adult amputation for vascular disease regardless of the level of injury. Several had primary closure of war wounds. After admission, four patients required plastic surgical procedures, two had ophthalmic surgery, one had a laparotomy and one had a facial reconstruction procedure in addition to surgery for extremity trauma. One child with fragment wounds was undergoing treatment for acute lymphoblastic leukaemia.

Conclusion: A military hospital must be prepared to treat children during war-time. Multi-system injury patterns are common and require multidisciplinary care. When possible children should be transferred to a facility with specialist care available for primary surgery. The effects of injury and treatment on future growth should be given more consideration.