Minimal fixation in the treatment of open hand and foot bone fractures caused by explosive devices: case series.

AIM: To evaluate minimal fixation method with Kirschner's wires in the treatment of open fractures of the hand and foot short bones, caused by explosive devices. METHOD: There were 270 wounded persons with open fractures of hand and foot short bones, who were surgically treated at the Department of Surgery at the Osijek University Hospital. The stabilization of an unstable open fracture was performed with intramedullary positioned Kirschner's wires. In a few cases, satisfactory stabilization was achieved with Kirschner's wires positioned percutaneously alongside the wound and perpendicularly through the fracture. In the rest of the wounded, plaster immobilization was sufficient after surgical treatment and fracture reposition. RESULTS: Among 270 persons with 412 open hand and foot bone fractures, 49% had fracture only in the feet, 27% only in the hands, and 24% in both hands and feet. Unstable short bone fractures were found in 56 patients (21%). Such fractures were stabilized with Kirschner's wires (n=71). In 58 patients (21%) partial hand and foot amputations had to be performed. Reconstructive operations to improve pseudarthrosis after minimal osteosynthesis were performed on 5 short bones (7%). Osteitis was found on four short bones (6%) after minimal osteosynthesis. CONCLUSION: Minimal osteosynthesis with Kirschner's wires is a reliable and adequate method of the treatment of open unstable short bone fractures caused by explosive devices.

External fixation as a primary and definitive treatment of open limb fractures.

This paper analyses the medical records of 5024 injured persons treated and operated on at the Surgical Clinic of the Clinical Hospital in Osijek, during the war against Croatia (1991 and 1992). There were 1653 (33.0 per cent) admitted, while the rest were treated as out-patients. Of the admitted patients 82.7 per cent (1372) had limb injuries. In 760 (15.0 per cent) of the wounded, 1320 limb fractures caused by explosives were diagnosed, out of which 856 were of the lower and 464 of the upper limbs. One hundred and ninety-two (3.9 per cent) were treated by external fixation. External fixators were applied to 147 lower and 68 upper open long bones, respectively. Adequate reconstructive operations were performed on 106 (2.1 per cent) patients with associated injuries to important blood vessels. The stabilization of the open and unstable external fractures was achieved by external fixation, mostly at one level, regardless of the wound size. The importance of good wound cleaning has been particularly stressed as well as bone fragment reposition. Special attention has been given to the preoperative and intra-operative assessment of the limbs. In 20 patients (9.3 per cent) treated with external fixation, osteitis occurred. Twenty-one more patients (9.7 per cent), because of bad fracture healing after external fixation, were submitted to secondary internal bone fixation combined with bone grafts. Out of these, nine (42.8 per cent) developed osteitis as a consequence of the additional treatment.

[Personal experience in the care of open fractures using external fixation during the hostilities in Osijek and surrounding region]. / Nase iskustvo u zbrinjavanju otvorenih prijeloma metodom vanjske fiksacije u periodu agresije na Osijek i okolinu.

In the period of aggression of the Federal Army and Serbian paramilitary forces on the City of Osijek and its surrounding, beginning in the summer of 1991, 4036 wounded were treated at the Department of Surgery, Osijek General Hospital. Extremity injuries were documented in 3889 patients, including 959 bone fractures. The majority of patients had wounds caused by highly destructive explosives filled with metal fragments of different shapes and dimensions, and having sharp and uneven edges. One hundred and forty wounded were treated by external fixators. In 102 patients this mode of fixation was applied for gun- and explosive-related long bone fractures of the lower extremities. External fixator for the upper and forearm fractures was used in 38 cases. During this period, different types of external fixators were used and experience in this work has been gained. Stability of both open and unstable bone fractures of the extremities, caused by explosive devices, has been obtained by the external fixation mostly in one plane, regardless of the type of external fixator used. The advantages of use of external fixators of the types Instrumentarija Zagreb 1 and 2 for the treatment of long bone fractures has been emphasized as well as the possibility of the subsequent corrections owing to the technical construction of the bone spike. The usefulness of the longitudinal bar of the AO/ASIF fixator for the healing of fractures of the upper leg with subsequent callus formation is also stressed. The same stability has been achieved by the CMC fixator. The external fixators of a type Zagreb 2 have been a satisfactory treatment for forearm fractures as well.(ABSTRACT TRUNCATED AT 250 WORDS)

[Radiologic analysis of osseous changes in coxarthrosis]. / Radioloska analiza osteogenetskih promjena kod korsartroza.

Morphologic and osteogenetic changes of the hip joint in patients with coxarthrosis were studied. Examination included 224 patients treated and operated on Department of Orthopaedics, Clinic Hospital Osijek. Coxarthrosis was proved in 331 hips, 183 cases (55,29%) referred to a secondary and 148 844,71%) to primary arthrosis. Osteogenetic changes on the head of femur were found in 148 x-rays (44,71%). The upper osteophyte of the head of femur was found in 79 x-rays of the hip (22,36%) but lower osteophyte of the head of femur only in 26 cases (7,85%). In 48 x-rays (14,50%) osteophytes were found both on the upper and lower sides of the head of femur. 217 x-rays of hips (65,56%) proved the existence of medial cervial osteophyte, according to frequency mostly type 1. Osteophyte of the roof of acetabulum were expressed on 158 x-rays (44,73). The double bottom of the acetabulum was studied on several measurement levels and showed from 0,24 to 2,35 mm observed from cranial to caudal measurement levels. The studies proved that the patients with coxarthrosis experienced a number of morphological and osteogenetic changes on the head and neck of femur as well as on the acetabulum. Their features on x-rays will depend on the cause and degree of the development of coxarthrosis.