[Treatment of severe osteoarticular injuries in under conditions of war].

Abstract

With the experience obtained in a surgical air borne unit and the long term results in a rear zone hospital, we analyse treatments of bone and joint acute traumas in a field hospital. This injuries appear in a particular context: delayed treatments with little staff and equipment. The surgeon has to be fast with protective measures, debridement of soft tissues, bone stabilisation and vascular repair. We discuss the respective place of each treatment: amputations are dictated by the gravity of the wounds; orthopedic methods are used for the upper limb, for the lower limb they are waiting technics; external fixation stabilizes fastly bone injuries, facilitates transportation and permits delayed reconstruction technics. Indications have to be adapted to circumstances: in a surgical unit with rear evacuation possibility the dramatic choice of amputation is often avoided by external fixator; in a short time mission for civilian populations, amputations are more often used but if conservative treatment is preferred, external fixator must be widely used.