ABSTRACT
INTRODUCTION: The management of ballistic fractures, which are open fractures, has often been studied in wartime and has benefited from the principles of military surgery with debridement and lavage, and the use of external fixation for bone stabilization. HYPOTHESIS: In civilian practice, bone stabilization of these fractures is different and is not performed by external fixation. PATIENTS AND METHODS: Fifteen civilian ballistic fractures, Gustilo II or IIIa, two associated with nerve damage and none with vascular damage, were reviewed. After debridement and lavage, ten internal fixations and five conservative treatments were used. RESULTS: No superficial or deep surgical site infection was noted. Fourteen of the 15 fractures (93%) healed without reoperation. Eleven of the 15 patients (73%) regained normal function. DISCUSSION: Ballistic fractures have a bad reputation due to their many complications, including infections. In civilian practice, the use of internal fixation is not responsible for excessive morbidity, provided debridement and lavage are performed. Civilian ballistic fractures, when they are caused by low-velocity firearms, differ from military ballistic fractures. Although the principle of surgical debridement and lavage remains the same, bone stabilization is different and is similar to conventional open fractures.
Subject(s)
Fractures, Comminuted/surgery , Fractures, Open/surgery , Wounds, Gunshot/surgery , Adult , Antibiotic Prophylaxis , Debridement , Female , Femoral Fractures/diagnostic imaging , Femoral Fractures/surgery , Fractures, Open/diagnostic imaging , Humans , Male , Middle Aged , Military Personnel , Radiography , Therapeutic Irrigation , Ulna Fractures/surgery , Wounds, Gunshot/diagnostic imaging , Young AdultABSTRACT
OBJECTIVES: The goal of our work was to evaluate the results of the Isis(®) trapeziometacarpal prosthesis. METHODS: Our retrospective study included 26 patients, 30 prosthesis. The mean follow-up was 30 months. Preoperatively, the pain was 8.1 out of 10, the QuickDASH was 68.5 and the average Kapandji score was 7.8. The Dell's stage was 2.3. The prosthesis used was hybrid: the trapezial cup was cemented in 90% of cases, and the metacarpal stem was cementless. RESULTS: Eighty-seven percent of patients were satisfied or very satisfied. At last follow-up, the pain was 3.4 out of 10, the QuickDASH was 37.8, and the average Kapandji score 9.1. The range of motion in flexion-extension and abduction-adduction were respectively 30.5° and 31.7±11°. The strength of the key-pinch, pulp-pinch and grasp averaged 75% of the contralateral side. On radiologic review, the rate of radiolucent lines was 20%, and the loosening or non-osteointegration rate 10%. No dislocation was noted. One surgical revision was necessary for symptomatic metacarpal non-osteointegration. The survival rate of the prosthesis was 93% at 42 months. DISCUSSION: Clinical results are good. However, the rate of abnormal radiographic images (30%) at 30 months follow-up must incite caution. Although these prosthetic loosenings seem to be less symptomatic, a longer follow-up is necessary to assess the sustainability of clinical results and the future of these periprosthetic radiolucent lines. This led us to change our practice to using noncemented prostheses from now on.
