title: [External fixator: treatment of choice in war traumatology].
abstract: External fixation: an appropriate treatment in war traumatology. Modern missiles cause important damage in the tissues. Apart from the presence of foreign bodies and of soil dirt in the site, the lesion is characterised by a certain instability, which is the result of the crushing and of the comminuted fractures as well as the lesion of the soft tissues. Delays during evacuation, unstable hospital facilities prohibit all forms of intrafocal osteosynthesis. If primary treatment determines the necessity of a large wound excision, of which the modalities have been described for centuries, it also improves a rigorous immobilisation of the site as only precaution against shock and infection. All techniques proposed during former conflicts prove that they are little adapted to the final goal. Their inadequacy can lead to amputation, at any rate to severe sequelae. In war traumatology, opposed to the shortcomings of non-operative methods and opposed to the prohibitions of intrafocal synthesis, external fixation is considered to be the best amongst compromises: they stabilise efficiently without being a risk, they retain the distance between bone fragments and prevent contracture of the muscles. They promote debridement of the wounds, they permit vascular repairs and control of the wounds, mobilisation of the limbs, they improve the injured's comfort and facilitate his evacuation. All types of external fixators can be used, but a number of military imperatives must be taken into account: fixing of the device must be easy to every user even with little training, a minimal number of parts must allow a maximal number of assemblies.(ABSTRACT TRUNCATED AT 250 WORDS)
mesh_terms: D005592:Fracture Fixation / Q000295:instrumentation* / Q000379:methods; D050723:Fractures, Bone / Q000209:etiology*; D006801:Humans; D009984:Orthopedic Fixation Devices / Q000009:adverse effects; D014857:Warfare; D014948:Wounds, Gunshot / Q000150:complications* / Q000628:therapy
vernacular_title: Le fixateur externe: un traitement de choix en traumatologie de guerre.