This study evaluates the need for limb reconstruction surgery in Syria and gives examples of how this service has been delivered by UK surgeons. The conflict in Syria has resulted in over 500,000 deaths and 1.2 million injured. There is not yet a centre for limb reconstruction surgery in the country. Injuries from gunshots and shrapnel were not common prior to the civil war resulting in a paucity of experience. The senior author spent two weeks in Syria to perform limb reconstruction surgery, to help to train local surgeons and assess the capacity of the facilities available to cope with the limb reconstruction workload.Introduction
Methods
The Essex-Lopresti injury (ELI) of the forearm
is a rare and serious condition which is often overlooked, leading
to a poor outcome. The purpose of this retrospective case study was to establish
whether early surgery can give good medium-term results. From a group of 295 patients with a fracture of the radial head,
12 patients were diagnosed with ELI on MRI which confirmed injury
to the interosseous membrane (IOM) and ligament (IOL). They were
treated by reduction and temporary Kirschner (K)-wire stabilisation
of the distal radioulnar joint (DRUJ). In addition, eight patients
had a radial head replacement, and two a radial head reconstruction. All patients were examined clinically and radiologically 59 months
(25 to 90) after surgery when the mean Mayo Modified Wrist Score
(MMWS) was 88.4 (78 to 94), the mean Mayo Elbow Performance Scores
(MEPS) 86.7 (77 to 95) and the mean disabilities of arm, shoulder
and hand (DASH) score 20.5 (16 to 31): all of these indicate a good outcome. In case of a high index of suspicion for ELI in patients with
a radial head fracture, we recommend the following: confirmation
of IOM and IOL injury with an early MRI scan; early surgery with
reduction and temporary K-wire stabilisation of the DRUJ; preservation
of the radial head if at all possible or replacement if not, and
functional bracing in supination. This will increase the prospect
of a good result, and avoid the complications of a missed diagnosis
and the difficulties of late treatment. Cite this article:
