Minimal Requirements for Open Reduction Internal Fixation in Austere Environments

Abstract

The aim of all fracture treatment is to promote bone healing and restore function. Open reduction and internal fixation (ORIF), increasingly the mainstay of fracture treatment in the developed world, aims to achieve this by anatomical reduction, appropriate fixation and early mobilisation. In the austere environment, however, many challenges exist to the provision of ORIF. The cost of implants is often seen as prohibitive, surgeons lack the required skills and there is concern regarding the possibility of deep infection due to suboptimal surgical sterility. In less than ideal settings, the surgical team has a duty of responsibility to provide a safe surgical environment, make rational judgements of the risk and benefit for each patient procedure and share a common attitude that limited resources are not necessarily tantamount to limited results.