Primary below knee amputation in the management of compound comminuted fracture lower tibia and fibula due to high velocity missile injury associated with bone loss and tibial nerve injury

Compound comminuted fractures of lower tibia and fibula are very common in Iraq these days due to missile injuries [bullets and blasts], it could be associated with bone loss and neurovascular injury this will interfere with the patients rehabilitation and leads to major social and economic burden on the patient, his family and the community. To prove that primary below knee amputation in management of compound comminuted fracture lower tibia and fibula due to high velocity missile injury and complete tibial nerve injury is superior to limb salvage. This is a prospective comparative study including 25 patients age 30-60 years presented to the emergency department in Medical City with a history of missile injury during the period 2005-2007 they had compound comminuted fractures of lower tibia and fibula [Gustilo grade II, III] all of them had different degrees of bone loss [more than 5 cm] and all of them had complete tibial nerve injury and 10 of them had associated posterior tibial artery injury which is irreparable. We divided our patients in to two groups the first one [9 patients four of them had also associated vascular injury] we did primary below knee amputation, while the second group [16 patients six of them had vascular injury] who refused amputation we did wound exsion and application of external fixation. Both groups followed up clinically and radiologically for one year. Group I the patients rehabilitated early and a prosthesis were used after one and a half month and the patients return to their original work or changing their work and have almost normal life, group II all of them had prolonged course of treatment with economic and social problems. Primary below knee amputation is a very good option for patients with history of compound comminuted fractures of lower tibia and fibula [grade II and III] associated with bone loss and tibial nerve injury. Decreasing rehabilitation time and early return back to work also less cost and less social problems

Management of compound comminuted fractures in and around elbow joint using across elbow external fixation followed by eearly active movement

Compound comminuted fractures around elbow are one of the most common injuries in our country today due to high velocity missile injuries they present a great challenge to the orthopaedic surgeon and severe suffering to the patients as comminution makes anatomical reduction impossible and stiffness is a well known associate .This study was designed to evaluate the functional outcome for such injuries. To evaluate the functional results of management of compound fractures in and around elbow joint using across elbow external fixation and early physiotherapy. A case series study was designed, a [20] patients presented to the orthopaedic and trauma department in the Medical City / Surgical Specialties teaching Hospital / Baghdad/ during the last two years 2006-2007, with history of high velocity missile injury to their elbow or around it, all of them treated by early wound excision and application of across elbow external fixation followed up for 6 weeks till healing of their wounds then the external fixation was removed and active assisted movement were started, patients followed up for 6 months and assessed both clinically and radiograph ically. Good range of elbow movement and return to the original work of the patients were noted in 100% of the patients, and follow up for the first 6 weeks after removal of the external fixation shows that most of the patients [15] got functional range of elbow movement, According to Mayo elbow performance score nine patient got 95 points and eleven got 85 points. Functional range of elbow movement can be achieved in compound comminuted fractures in and around elbow by using external fixation across the joint then physiotherapy