Skip to main content
SpringerLink
Log in

External Fixator Applications in Warfare Surgery

  • Chapter
  • First Online:
Book cover Basic Techniques for Extremity Reconstruction

  • 1368 Accesses

Abstract

One of the most common war injuries is limb injury. Modern high-energy weapons expose serious damage in soft tissue and the bone. Aggressive irrigation and debridement is very important for firearm wounds with extensive soft tissue damage. It must be kept in mind that penetrating trauma increases the incidence of vascular and neurologic injury. After wound care, the fracture should be fixed. Early stabilization reduces secondary injury, pulmonary complications, ARDS, infection, and hospital length of stay. External fixators can be applied for the fractures as uniplanar, biplanar, or multiplanar or temporarily or permanently according to the type of the fracture, severity of soft tissue damage, and site of fracture.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Nikolić D, Jovanović Z, Popović Z, Vulović R, Mladenović M. Primary surgical treatment of war injuries of major joints of the limbs. Injury. 1999;30(2):129–34.

    Article  PubMed  Google Scholar 

  2. Nance ML, Stafford PW, Schwab CW. Firearm injury among urban youth during the last decade: an escalation in violence. J Pediatr Surg. 1997;32(7):949–52.

    Article  CAS  PubMed  Google Scholar 

  3. Dicpinigaitis PA, Koval KJ, Tejwani NC, Egol KA. Gunshot wounds to the extremities. Bulletın-Hospıtal For Joınt Dıseases New York. 2006;64(3/4):139.

    Google Scholar 

  4. Dickson K, Watson TS, Haddad C, Jenne J, Harris M. Outpatient management of low-velocity gunshot-induced fractures. Orthopedics. 2001;24(10):951.

    CAS  PubMed  Google Scholar 

  5. Islinger RB. A review of orthopedic injuries in three recent US military conflicts. Mil Med. 2000;165(6):463.

    CAS  PubMed  Google Scholar 

  6. Bach AW, Hansen Jr ST. Plates versus external fixation in severe open tibial shaft fractures: a randomized trial. Clin Orthop Relat Res. 1989;241:89–94.

    Google Scholar 

  7. Bowyer GW, Rossiter ND. Management of gunshot wounds of the limbs. J Bone Joint Surg Br. 1997;79(6):1031–6. Review . PubMed

    Article  CAS  PubMed  Google Scholar 

  8. Shepard GH. High-energy, low-velocity close-range shotgun wounds. J Trauma. 1980;20(12):1065–7. PubMed

    Article  CAS  PubMed  Google Scholar 

  9. Woloszyn JT, Uitvlugt GM, Castle ME. Management of civilian gunshot fractures of the extremities. Clin Orthop Relat Res. 1988;226:247–51. PubMed

    Google Scholar 

  10. Sitzinan JV, Ernst CB. Management of arm arterial injuries. Surgery. 1984;96:895.

    Google Scholar 

  11. Sirinek KR, Levine BA, Gaskill 3rd HV, Root HD. Reassessment of the role of routine operative exploration in vascular trauma. J Trauma. 1981;21(5):339–44.

    Article  CAS  PubMed  Google Scholar 

  12. Drapanas T, Hewitt RL, Weichert 3rd RF, Smith AD. Civilian vascular injuries: a critical appraisal of three decades of management. Ann Surg. 1970;172(3):351–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Omer Jr GE. Injuries to nerves of the upper extremity. J Bone Joint Surg Am. 1974;56(8):1615–24.

    Article  PubMed  Google Scholar 

  14. Brien EW, Brien WW, Long WT, Kuschner SH. Concomitant injuries of the hip joint and abdomen resulting from gunshot wounds. Orthopedics. 1992;15:1317–9. ; discussion 1319- 20

    CAS  PubMed  Google Scholar 

  15. Gellman RE, Paiement GD, Green HD, Coughlin RR. Treatment of supracondylar femoral fractures with a retrograde intramedullary nail. Clin Orthop Relat Res. 1996;332:90–7.

    Article  Google Scholar 

  16. Cleveland M, Manning JG, Stewart WJ. Care of battle casualties and injuries involving bones and joints. J Bone Joint Surg Am. 1951;33(2):517–27.

    Article  PubMed  Google Scholar 

  17. Pape HC, Hildebrand F, Pertschy S, Zelle B, Garapati R, Grimme K, Krettek C, Reed 2nd RL. Changes in the management of femoral shaft fractures in polytrauma patients: from early total care to damage control orthopedic surgery. J Trauma. 2002;53(3):452.

    Article  PubMed  Google Scholar 

  18. Stein JS, Strauss E. Gunshot wounds to the upper extremity. Evaluation and management of vascular injuries. Orthop Clin North Am. 1995;26(1):29–35.

    CAS  PubMed  Google Scholar 

  19. Brundage SI, McGhan R, Jurkovich GJ, Mack CD, Maier RV. Timing of femur fracture fixation: effect on outcome in patients with thoracic and head injuries. J Trauma. 2002;52:299–307.

    PubMed  Google Scholar 

  20. Carroll EA, Andrew Koman L. External fixation and temporary stabilization of femoral and tibial trauma. J Surg Orthop Adv. 2011;20(1):74.

    PubMed  Google Scholar 

  21. Bible JE, Mir HR. External fixation: principles and applications. J Am Acad Orthop Surg. 2015;23(11):683–90.

    Article  PubMed  Google Scholar 

  22. Ilızarov GA. The tension-stress effect on the genesis and growth of tissues: Part I The influence of stability of fixation and soft-tissue preservation. Clin Orthop Relat Res. 1989;238:249–81.

    Google Scholar 

  23. Ziran BH, Smith WR, Anglen JO, Tornetta P. External fixation: how to make it work. J Bone Joint Surg. 2007;89(7):1620–32.

    Article  PubMed  Google Scholar 

  24. Matthews LS, Green CA, Goldstein SA. The thermal effects of skeletal fixation-pin insertion in bone. J Bone Joint Surg Am. 1984;66(7):1077–83.

    Article  CAS  PubMed  Google Scholar 

  25. Moroni A, Vannini F, Mosca M, Giannini S. State of the art review: techniques to avoid pin loosening and infection in external fixation. J Orthop Trauma. 2002;16(3):189–95.

    Article  PubMed  Google Scholar 

  26. Jorgenson DS, Antoine GA. Advances in the treatment of lower extremity wounds applied to military casualties. Ann Plast Surg. 1995;34(3):298–303.

    Article  CAS  PubMed  Google Scholar 

  27. Norman J, Gahtan V, Franz M, Bramson R. Occult vascular injuries following gunshot wounds resulting in long bone fractures of the extremities. Am surg. 1995;61(2):146–50.

    CAS  PubMed  Google Scholar 

  28. Ali F, Saleh M. Treatment of isolated complex distal femoral fractures by external fixation. Injury. 2000;31(3):139–46.

    Article  CAS  PubMed  Google Scholar 

  29. H.C P, Rixen D, Morley J, E.E H, Mueller M, Dumont C, EPOFF Study Group. Impact of the method of initial stabilization for femoral shaft fractures in patients with multiple injuries at risk for complications. Ann Surg. 2007;246(3):491.

    Article  Google Scholar 

  30. Perry DJ, Sanders DP, Nyirenda CD, Lezine-Hanna JT. Gunshot wounds to the knee. Orthop Clin N Am. 1995;26(1):155–63.

    CAS  Google Scholar 

  31. Esterhai Jr JL, Queenan J. Management of soft tissue wounds associated with type III open fractures. Orthop Clin N Am. 1991;22(3):427–32.

    Google Scholar 

  32. Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma Acute Care Surg. 1984;24(8):742–6.

    Article  CAS  Google Scholar 

  33. Velazco A, Fleming LL. Open fractures of the tibia treated by the Hoffmann external fixator. Clin Orthop Relat Res. 1983;180:125–32.

    Google Scholar 

  34. Oh CW, Song HR, Roh JY, Oh JK, Min WK, Kyung HS, et al. Bone transport over an intramedullary nail for reconstruction of long bone defects in tibia. Arch Orthop Trauma surg. 2008;128(8):801–8.

    Article  PubMed  Google Scholar 

  35. Ilizarov GA, Ledyaev VI. The Replacement of Long Tubular Bone Defects by Lengthening Distraction Osteotomy of One of the Fragments. Clin Orthop Relat Res. 1992;280:7–10.

    Google Scholar 

  36. Dayton PD, Risser J. Handgun injuries to the foot: treatment of low-velocity, high-energy wound types. J Foot surg. 1989;29(4):309–17.

    Google Scholar 

  37. Casey D, McConnell T, Parekh S, Tornetta Iii P. Percutaneous pin placement in the medial calcaneus: is anywhere safe? J Orthop Trauma. 2002;16(1):26–9.

    Article  PubMed  Google Scholar 

  38. Spencer AD. The reliability of signs of peripheral vascular injury. Surg Gynecol Obstet. 1962;114:490–4.

    CAS  PubMed  Google Scholar 

  39. Swan KG, Swan RC. The extremities. In:Gunshot wounds:pathophysiology and management. Chicago: Year Book Medical Publishers; 1989. p. 217–74.

    Google Scholar 

  40. Bartlett 3rd GS, Hausman MR, Witschi TH. Gunshot wounds to the shoulder. Orthop Clin North Am. 1995;26(1):37–53.

    PubMed  Google Scholar 

  41. Snyder 3rd WH, Borman KR. Upper extremity vascular trauma. In: Flanigan DP, editor. Civilian vascular trauma. Malvern: Lea and Febiger; 1992. p. 157.

    Google Scholar 

  42. Najibi S, Dougherty PJ, Morandi M. Management of gunshot wounds to the joints. Techniques in Orthopaedics. 2006;21(3):200–204. Ordog GJ, Wasserberger J, Balasubramanium S, et al.Civilian gunshot wounds–outpatient management. J Trauma. 1994;36(1):106–11.

    Article  Google Scholar 

  43. Otero F, Cuartas E. Arthroscopic removal of bullet fragments from the subacromial space of the shoulder. Arthroscopy. 2004;20(7):754–6.

    Article  PubMed  Google Scholar 

  44. Tarkin IS, Hatzidakis A, Hoxie SC, et al. Arthroscopic treatment of gunshot wounds to the shoulder. Arthroscopy. 2003;19(1):85–9.

    Article  PubMed  Google Scholar 

  45. Zellweger R, Hess F, Nicol A, et al. An analysis of 124 surgically managed brachial artery injuries. Am J Surg. 2004;188(3):240–5.

    Article  PubMed  Google Scholar 

  46. Guo Y, Chiou-Tan FY. Radial nerve injuries from gunshot wounds and other trauma: Comparison of electrodiagnostic findings. Am J Phys Med Rehabil. 2002;81(3):207–11.

    Article  PubMed  Google Scholar 

  47. Shao YC, Harwood P, Grotz MR, et al. Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review. J Bone Joint Surg Br. 2005;87(12):1647–52.

    Article  CAS  PubMed  Google Scholar 

  48. Attias N, Lehman RE, Bodell LS. et al.Surgical management of a long segmental defect of the humerus using a cylindrical titanium mesh cage and plates:A case report. J Orthop Trauma. 2005;19(3):211–6.

    Article  PubMed  Google Scholar 

  49. Balfour GW, Marrero CE. Fracture brace for the treatment of humerus shaft fractures caused by gunshot wounds. Orthop Clin North Am. 1995;26(1):55–63.

    CAS  PubMed  Google Scholar 

  50. Hall Jr RF, Pankovich AM. Ender nailing of acute fractures of the humerus. A study of closed fixation by intramedullary nails without reaming. J Bone Joint Surg Am. 1987;69(4):558–67.

    Article  PubMed  Google Scholar 

  51. Johnson EC, Strauss E. Recent advances in the treatment of gunshot fractures of the humeral shaft. Clin Orthop Relat Res. 2003;408:126–32.

    Article  Google Scholar 

  52. Joshi A, Labbe M, Lindsey RW. Humeral fracture secondary to civilian gunshot injury. Injury. 1998;29(suppl 1):SA13–7.

    Article  PubMed  Google Scholar 

  53. Keller A. The management of gunshot fractures of the humerus. Injury. 1995;26(2):93–6.

    Article  CAS  PubMed  Google Scholar 

  54. Kömürcü M, Yanmis I, Ates¸alp AS, et al. Treatment results for open comminuted distal humerus intra-articular fractures with Ilizarov circular external fixator. Mil Med. 2003;168(9):694–7.

    PubMed  Google Scholar 

  55. Sarmiento A, Latta L. The evolution of functional bracing of fractures. J Bone Joint Surg Br. 2006;88(2):141–8.

    Article  CAS  PubMed  Google Scholar 

  56. Sarmiento A, Zagorski JB, Zych GA, et al. Functional bracing for the treatment of fractures of the humeral diaphysis. J Bone Joint Surg Am. 2000;82(4):478–86.

    Article  CAS  PubMed  Google Scholar 

  57. Wisniewski TF, Radziejowski MJ. Gunshot fractures of the humeral shaft treated with external fixation. J Orthop Trauma. 1996;10(4):273–8.

    Article  CAS  PubMed  Google Scholar 

  58. Karas EH, Strauss E, Sohail S. Surgical stabilization of humeral shaft fractures due to gunshot wounds. Orthop CliNorth Am. 1995;26(1):65–73.

    CAS  Google Scholar 

  59. Hinsenkamp M, Burny F, Andrianne Y, et al. External fixation of the fracture of the humerus. A review of 164 cases. Orthopedics. 1984;7:1309.

    CAS  PubMed  Google Scholar 

  60. Zinman C, Norman D, Hamoud K, et al. External fixation for severe open fractures of the humerus caused by missiles. J Orthop Trauma. 1997;11(7):536–9.

    Article  CAS  PubMed  Google Scholar 

  61. Elstrom JA, Pankovich AM, Egwele R. Extra-articular low-velocity gunshot fractures of the radius and ulna. J Bone Joint Surg Am. 1978;60(3):335–41.

    Article  CAS  PubMed  Google Scholar 

  62. Fackler ML, Burkhalter WE. Hand and forearm injuries from penetrating projectiles. J Hand Surg Am. 1992;17(5):971–5.

    Article  CAS  PubMed  Google Scholar 

  63. Georgiadis GM, DeSilva SP. Reconstruction of skeletal defects in the forearm after trauma: Treatment with cement spacer and delayed cancellous bone grafting. J Trauma. 1995;38(6):910–4.

    Article  CAS  PubMed  Google Scholar 

  64. Hahn M, Strauss E, Yang EC. Gunshot wounds to the forearm. Orthop Clin North Am. 1995;26(1):85–93.

    CAS  PubMed  Google Scholar 

  65. Hennessy MJ, Banks HH, Leach RB, et al. Extremity gunshot wound and gunshot fracture in civilian practice. Clin Orthop Relat Res. 1976;114:296–303.

    Google Scholar 

  66. Robert RH. Gunshots to the hand and upper extremity. Clin Orthop Relat Res. 2003;408:133–44.

    Article  Google Scholar 

  67. Rodrigues RL, Sammer DM, Chung KC. Treatment of complex below-the-elbow gunshot wounds. Ann Plast Surg. 2006;56(2):122–7.

    Article  CAS  PubMed  Google Scholar 

  68. Wu CD. Low-velocity gunshot fractures of the radius and ulna: case report and review of the literature. J Trauma. 1995;39(5):1003–5.

    Article  CAS  PubMed  Google Scholar 

  69. Moed BR, Fakhouri AJ. Compartment syndrome after low-velocity gunshot wounds to the forearm. J Orthop Trauma. 1991;5(2):134–7.

    Article  CAS  PubMed  Google Scholar 

  70. Lenihan MR, Brien WW, Gellman H, Itamura J, Kuschner SH. Fractures of the forearm resulting from low-velocity gunshot wounds. J Orthop Trauma. 1992;6(1):32–5.

    CAS  PubMed  Google Scholar 

  71. Chapman MW, Mahoney M. The role of early internal fixation in the management of open fractures. Clin Orthop Relat Res. 1979;138:120–31.

    Google Scholar 

  72. Jones JA. Immediate internal fixation of high-energy open forearm fractures. J Orthop Trauma. 1991;5(3):272–9.

    Article  CAS  PubMed  Google Scholar 

  73. Grimsrud C, Siebler J. Small fragment locking plate as provisional internal fixation in severe open both-bone forearm fractures. J Hand Surg Am. 2014;39(8):1615–9.

    Article  PubMed  Google Scholar 

  74. Brannon JK, Woods C, Chandran RE, et al. Gunshot wounds to the elbow. Orthop Clin North Am. 1995;26(1):75. 84

    CAS  PubMed  Google Scholar 

  75. Burkhalter A, Ballard WE. Orthopedic surgery in Vietnam. In:Medical Department, United States Army, Surgery in Vietnam. Washington, DC: Office of the Surgeon General and Center for Military History; 1994.

    Google Scholar 

  76. Demiralp B, Komurcu M, Ozturk C, et al. Total elbow arthroplasty in patients who have elbow fractures caused by gunshot injuries: 8- to 12-year follow-up study. Arch Orthop Trauma Surg. 2008;128(1):17–24.

    Article  PubMed  Google Scholar 

  77. McAuliffe JA, Burkhalter WE, Ouellette EA, et al. Compression plate arthrodesis of the elbow. J Bone Joint Surg Br. 1992;74(2):300–4.

    CAS  PubMed  Google Scholar 

  78. Phillips 3rd P, Hansraj KK, Cox 2nd EE, Ashley EM. Gunshot wounds to the hand. The Martin Luther King, Jr, general hospital experience. Orthop Clin North Am. 1995;26(1):95–108.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Hand Surgery, Department of Orthopedics Surgery and Traumatology, University of Health Sciences, Ankara, Turkey

    Mustafa kürklü MD

  2. Department of Orthopedics Surgery and Traumatology, Private Doctor Bayram Öztürk Hospital, Ankara, Turkey

    Yüksel Yurttaş MD

  3. Division of Hand Surgery, Department of Orthopedics Surgery and Traumatology, Gulhane Research and Training Hospital, Ankara, Turkey

    Harun Yasin Tüzün MD

  4. Department of Orthopedics Surgery and Traumatology, Private Keçiören Hospital, Ankara, Turkey

    Mustafa Başbozkurt MD

Authors
  1. Mustafa kürklü MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yüksel Yurttaş MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Harun Yasin Tüzün MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mustafa Başbozkurt MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mustafa kürklü MD .

Editor information

Editors and Affiliations

  1. Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey

    Mehmet Çakmak

  2. Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey

    Cengiz Şen

  3. Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey

    Levent Eralp

  4. Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey

    Halil Ibrahim Balci

  5. Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey

    Melih Civan

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing Switzerland

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

kürklü, M., Yurttaş, Y., Tüzün, H.Y., Başbozkurt, M. (2018). External Fixator Applications in Warfare Surgery. In: Çakmak, M., Şen, C., Eralp, L., Balci, H., Civan, M. (eds) Basic Techniques for Extremity Reconstruction. Springer, Cham. https://doi.org/10.1007/978-3-319-45675-1_40

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-45675-1_40

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-45673-7

  • Online ISBN: 978-3-319-45675-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation