Decision-making algorithm for sequential treatment of diaphyseal bone gaps in war-wounded patients in the Middle East

International Orthopaedics
Rasheed M FakhriAli M K Al Ani

Abstract

Tibial bone gaps after war injuries are common and can be managed by different types of surgery, including compression, bone graft, tibialisation of fibula, bone transport, and free flaps. Here, we present an algorithm developed at a humanitarian surgical hospital to manage tibial bone gaps. We also identify some key factors affecting patient outcomes and describe some clinical considerations for choosing treatment strategy. We performed retrospective data analysis on war-wounded adult patients with tibial injuries treated at our project according to the described algorithm. Patient outcomes were followed for at least four  years. Outcomes assessed were length of stay, complication rate, re-admission (late complications), and final discharge. Among the 200 included patients, 103 (51.5%) had bone gaps. Univariate analysis showed that the presence of a bone gap, but not its size, was associated with significantly increased risk of early complications, while type of surgery was significantly correlated with re-admission. Presence of a bone gap and type of surgery were each significantly associated with length of stay. Bone gap size showed no correlation with outcomes, an unexpected finding. Soft tissue damage with compromised vasc...Continue Reading

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Jan 20, 2017·International Orthopaedics·Patrick HérardRasheed M Fakhri
Sep 25, 2017·Journal of Orthopaedic Trauma·Emil H Schemitsch

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Citations

Oct 20, 2019·International Orthopaedics·Reem A KaramiAmir E Ibrahim
Dec 14, 2019·International Orthopaedics·Marius M ScarlatJames P Waddell
Apr 12, 2019·International Orthopaedics·Marius M Scarlat

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