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International Orthopaedics

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01-12-2019 | Original Paper

Decision-making algorithm for sequential treatment of diaphyseal bone gaps in war-wounded patients in the Middle East

Authors: Rasheed M. Fakhri, Patrick Herard, Mohammed I. Liswi, Anne L. Boulart, Ali M. K. Al Ani

Published in: International Orthopaedics | Issue 12/2019

Abstract

Introduction

Tibial bone gaps after war injuries are common and can be managed by different types of surgery, including compression, bone graft, tibialisation of fibula, bone transport, and free flaps. Here, we present an algorithm developed at a humanitarian surgical hospital to manage tibial bone gaps. We also identify some key factors affecting patient outcomes and describe some clinical considerations for choosing treatment strategy.

Method

We performed retrospective data analysis on war-wounded adult patients with tibial injuries treated at our project according to the described algorithm. Patient outcomes were followed for at least four years. Outcomes assessed were length of stay, complication rate, re-admission (late complications), and final discharge.

Results

Among the 200 included patients, 103 (51.5%) had bone gaps. Univariate analysis showed that the presence of a bone gap, but not its size, was associated with significantly increased risk of early complications, while type of surgery was significantly correlated with re-admission. Presence of a bone gap and type of surgery were each significantly associated with length of stay. Bone gap size showed no correlation with outcomes, an unexpected finding.

Discussion

Soft tissue damage with compromised vascularity may explain the lack of association between bone gap size and outcomes. Specialised centres using standardised approaches to complex surgical reconstruction can play an important role in expanding the evidence base needed to improve case management.

Conclusions

Less invasive procedures may lead to better patient outcomes, although unfortunately may not always be possible given the nature of the injury and/or injury site.

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Title: Decision-making algorithm for sequential treatment of diaphyseal bone gaps in war-wounded patients in the Middle East
Authors: Rasheed M. Fakhri
Patrick Herard
Mohammed I. Liswi
Anne L. Boulart
Ali M. K. Al Ani
Publication date: 01-12-2019
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 12/2019
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-019-04317-x

At a glance: The STEP trials

Springer Medicine

Decision-making algorithm for sequential treatment of diaphyseal bone gaps in war-wounded patients in the Middle East

Abstract

Introduction

Method

Results

Discussion

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Method

Results

Discussion

Conclusions

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