An Innovative Technique for Intraoperative Radiological Assessment of Pelvic and Spine Fractures in Austere Environment.

INTRODUCTION: Managing pelvic and spine fractures in the austere environment can be challenging even for skilled orthopedic surgeons, largely due to the difficulty of radiological visualization of bone structures. We present a simple alternative to the metallic operating table by placing the patient on a spinal board that will allow for a better radiological assessment of these fractures. MATERIAL AND METHODS: A cross-sectional, descriptive, and retrospective study was carried out in the period between 2015 and 2020. The study population was all patients with pelvic o spine fractures, managed surgically using a spinal board in the Spanish Role 2 or in the Spanish Role 4. RESULTS: Seven patients underwent surgery in total using a spinal board, pelvic fracture being the the main diagnosis (n = 6; 85.71%). The distribution of surgical procedures was as follows: percutaneous pedicle screw fixation (one case), external fixation of the pelvis (two cases), percutaneous screw fixation of the pelvis (two cases), and open reduction and internal fixation of the pelvis (two cases). The mean duration of surgical interventions was 52 minutes, and a successful reduction and synthesis of the fracture was obtained in all the patients, with no complications reported. CONCLUSION: A spinal board can be a useful, simple, and effective device for the orthopedic surgeon in the deployed setting. The described technique is simple, fast, and efficient in getting a complete radiological assessment of complex regions such as the pelvis and the spine, facilitating the surgical management of these injuries.

A Comparative Study Between Two Combat Injury Severity Scores.

INTRODUCTION: In recent years, specific trauma scoring systems have been developed for military casualties. The objective of this study was to examine the discrepancies in severity scores of combat casualties between the Abbreviated Injury Scale 2005-Military (mAIS) and the Military Combat Injury Scale (MCIS) and a review of the current literature on the application of trauma scoring systems in the military setting. METHODS: A cross-sectional, descriptive, and retrospective study was conducted between May 1, 2005, and December 31, 2014. The study population consisted of all combat casualties attended in the Spanish Role 2 deployed in Herat (Afghanistan). We used the New Injury Severity Score (NISS) as reference score. Severity of each injury was calculated according to mAIS and MCIS, respectively. The severity of each casualty was calculated according to the NISS based on the mAIS (Military New Injury Severity Score-mNISS) and MCIS (Military Combat Injury Scale-New Injury Severity Score-MCIS-NISS). Casualty severity were grouped by severity levels (mild-scores: 1-8, moderate-scores: 9-15, severe-scores: 16-24, and critical-scores: 25-75). RESULTS: Nine hundred and eleven casualties were analyzed. Most were male (96.37%) with a median age of 27 years. Afghan patients comprised 71.13%. Air medevac was the main casualty transportation method (80.13). Explosion (64.76%) and gunshot wound (34.68%) mechanisms predominated. Overall mortality was 3.51%. Median mNISS and MCIS-NISS were similar in nonsurvivors (36 [IQR, 25-49] vs. [IQR, 25-48], respectively) but different in survivors, 9 (IQR, 4-17) vs. 5 (IQR, 2-13), respectively (P < .0001). The mNISS and MCIS-NISS were discordant in 34.35% (n = 313). Among cases with discordant severity scores, the median difference between mNISS and MCIS-NISS was 9 (IQR, 4-16); range, 1 to 57. CONCLUSION: Our study findings suggest that discrepancies in injury severity levels may be observed in one in three of the casualties when using mNISS and MCIS-NISS.

Multi-stage surgery for a multiple-level spondylodiscitis caused by multidrug-resistant Mycobacterium avium complex.

The objective of this article is to report a rare case of atypical mycobacterial spinal spondylodiscitis with multiple-level involvement and the successful treatment by multi-stage surgical intervention. Reports on the surgical management of atypical mycobacterial spondylodiscitis are lacking. A 71-year-old woman with a confirmed diagnosis of multiple-level spondylodiscitis of L2-L3 and L5-S1 caused by Mycobacterium avium complex (MAC). The patient underwent a two-stage surgical treatment (first: posterior instrumentation; second: anterior debridement with anterior lumbar interbody fusion). At 1 year after surgery, the patient suffered a proximal junctional failure secondary to a vertebral fracture that was solved with a proximal extension of the fusion using a percutaneous technique. The patient was successfully discharged with good pain control, satisfactory correction, no neurologic complications and an overall satisfactory outcome. A rare case of antibiotic-resistant multi-level spondylodiscitis due to MAC was treated successfully with multi-stage surgical treatment. Surgery in this patient group remains challenging due to the technical complexities and the difficulty of choosing the instrumentation levels.

Analysis of evacuations from areas of operation to the Spanish Role 4 medical treatment facility (2008-2013).

Since 1987, the Spanish Armed Forces have deployed their troops in a multitude of conflicts and natural disasters worldwide. The Spanish Military Medical Corps has the ability to deploy Role 1, Role 2, and one Role 3 medical treatment facilities. It also has a Role 4 in operation, the "Gómez Ulla" Central Hospital of Defense, in Madrid. The aim of this study is to describe the type of Spanish casualties evacuated from different areas of operation to the Role 4 from 2008 to 2013. A retrospective, cross-sectional study was performed on a sample of 232 patients. Among these, 211 (91%) were noncombat casualties: 126 because of illness, 53 because of an accident, and 32 because of sports injuries. The remaining 21 (9%) were combat casualties: 11 from improvised explosive devices and 10 from gunfire. Afghanistan, followed by Lebanon, is the operational area where most evacuees originate. The authors consider it essential that the Spanish Armed Forces rely on a Role 4 medical treatment facility as part of their medical support to international operations.