[Ilisarov callus distraction and callus compression in treatment of defect gunshot fractures, pseudarthroses and post-traumatic deformities in developing countries. A report of experiences in Cambodian and Ethiopian provincial hospitals]. / Kallusdistraktion und Kalluskompression nach Ilisarov in der Behandlung von Defektschussbrüchen, Pseudarthrosen und posttraumatischen Fehlstellungen in Ländern der Dritten Welt. Ein Erfahrungsvericht aus Provinzhospitälern Kambodschas and Athiopiens.

Between March 1989 and May 1993, a total of 22 patients were treated by Ilisarov's method of callus distraction and compression in provincial hospitals in Cambodia and Ethiopia. In both countries were times of civil war and unrest. The indications were high-velocity gunshot and explosive injuries with defect fractures (9 patients), infected and non-infected non-unions after gunshot injuries (6 patients) and civil accidents (3 patients), and deformities after civil accidents and gunshot injuries (4 patients). The deformities were leg shortening by between 5 and 7 cm and in 1 case ankylosis of the knee joint in 110 degrees flexion. A simple unilateral or V-shaped external fixator with devices for distraction and compression was applied. The results in 19 patients are known, while 3 patients have been lost to follow-up since discharge. In 1 case of an infected defect fracture (12 cm) fo the femur amputation was necessary because of sepsis. In all 6 other cases the bone defects were bridged by means of segmental transport, distraction and compression; in all 3 cases of shortening it was possible to restore the original length; similarly, in the case of knee joint ankylosis flexion of 10 degrees was achieved. All 5 infected non-unions healed well after sequesterectomy and segmental bone transport with distraction and compression, and the same holds for the 3 non-infected non-unions. However, in 7 cases a minor spongiosa bone graft was needed to consolidate the ossification at the contact point after distraction and/or compression.(ABSTRACT TRUNCATED AT 250 WORDS)

Wartime colon injuries: primary repair or colostomy?

A retrospective non-randomized study, comparing primary repair with colostomy, was made on a series of 102 patients with penetrating intraperitoneal colon injuries, in a war surgery programme in Cambodia. The overall case fatality rate (CFR) was 25.5%, whereas in the primary repair group CFR was 20%, compared to 30.8% in the colostomy group. The difference was not statistically significant (P = 0.30). Adjustment for possible confounding factors in the two groups did not alter the results. Considering the numerous advantages to the patient of a primary closure in the precarious situations where war surgery is often performed, this technique merits consideration.