Introduction: Children are inevitably casualties in
During the second Lebanon
Over the centuries there has been a pattern of order developing from chaos in the behaviour of nations. The 20th century has demonstrated major conflict between nations, and Defence Health has supported the core activity of the Australian Defence Force (ADF), which has been the aim of military medicine generally in all world defence forces. Preventative medicine and mass casualty treatment, as well as the maintenance of health and return to duty from minor injuries, has been a success for all traditional military medical structures. It has been known that if the civilian population is supportive of the military effort, this is a significant advantage. The military medical assets directed in this manner to the local civilians builds bridges for lasting peace. In 1989 the world changed, with the Cold
During the second Gulf
Cluster bombs are an inhuman weaponary, intended, among other things, for mass kiling of humans. The use of modern weaponary can cause very serious damage of all structures in injured extremity. During the
A patient with a chronic discharging sinus or an extensive adherent scar is never safe from the risk of malignant change. Examples are still occurring more than thirty years after the end of the first world
Aims: To evaluate the clinical outcome of the treatment of severe high-energy
Introduction and aims. We present a series of patients who have had secondary reconstruction of
Introduction. We present a series of patients who have had secondary reconstruction of
Objective The aim of this study was to prospectively study the effectiveness of external fixation for
A randomised controlled trial was conducted using a rabbit model of a complex contaminated extremity
A 7-day randomised controlled pre-clinical trial utilising an existing extremity
A randomised controlled pre-clinical trial utilising an existing extremity
This paper outlines the history of advances made in the treatment of open fractures that have occurred during wartime.
Over 200 high-velocity missile injuries treated in a low-technology environment were audited under the aegis of the International Committee of the Red Cross Hospitals in Afghanistan and Northern Kenya. Femoral fractures were treated either by traction or external fixation using a uniaxial frame. The results showed that patients treated by external fixation remained in hospital longer than those treated on traction. The positional outcome was identical in both groups. In tibial fractures the external fixator was only of extra benefit in those of the lower third when compared with simple plaster slabs unless more complex procedures such as flaps or vascular repair were to be performed. In complex humeral fractures, external fixation resulted in long stays in hospital and a large number of interventions when compared with simple treatment in a sling. We conclude therefore that in an environment where facilities are limited and surgeons have only general experience very careful initial wound excision is the most important factor determining outcome. The application of complex holding techniques was generally inappropriate.
1. The background to the work of Australian medical teams in South Vietnam is described. 2. The types of limb wounds seen among the Vietnamese civilian population are classified and described, and the methods of treatment used are reported.
This is a retrospective study of survivors of
recent conflicts with an open fracture of the femur. We analysed
the records of 48 patients (48 fractures) and assessed the outcome.
The median follow up for 47 patients (98%) was 37 months (interquartile
range 19 to 53); 31 (66%) achieved union; 16 (34%) had a revision
procedure, two of which were transfemoral amputation (4%). The New Injury Severity Score, the method of fixation, infection
and the requirement for soft-tissue cover were not associated with
a poor outcome. The degree of bone loss was strongly associated
with a poor outcome (p = 0.00204). A total of four patients developed
an infection; two with This study shows that, compared with historical experience, outcomes
after open fractures of the femur sustained on the battlefield are
good, with no mortality and low rates of infection and late amputation.
The degree of bone loss is closely associated with a poor outcome. Cite this article:
This is a case series of prospectively gathered
data characterising the injuries, surgical treatment and outcomes
of consecutive British service personnel who underwent a unilateral
lower limb amputation following combat injury. Patients with primary,
unilateral loss of the lower limb sustained between March 2004 and
March 2010 were identified from the United Kingdom Military Trauma
Registry. Patients were asked to complete a Short-Form (SF)-36 questionnaire.
A total of 48 patients were identified: 21 had a trans-tibial amputation,
nine had a knee disarticulation and 18 had an amputation at the
trans-femoral level. The median New Injury Severity Score was 24 (mean
27.4 (9 to 75)) and the median number of procedures per residual
limb was 4 (mean 5 (2 to 11)). Minimum two-year SF-36 scores were
completed by 39 patients (81%) at a mean follow-up of 40 months
(25 to 75). The physical component of the SF-36 varied significantly
between different levels of amputation (p = 0.01). Mental component
scores did not vary between amputation levels (p = 0.114). Pain
(p = 0.332), use of prosthesis (p = 0.503), rate of re-admission
(p = 0.228) and mobility (p = 0.087) did not vary between amputation
levels. These findings illustrate the significant impact of these injuries
and the considerable surgical burden associated with their treatment.
Quality of life is improved with a longer residual limb, and these
results support surgical attempts to maximise residual limb length. Cite this article: