title: Outcomes of internal fixation in a combat environment.
abstract: Due to the nature of the wounds and environment, internal fixation in battlefield treatment facilities is discouraged despite the lack of data. The purpose of this review is to describe the outcomes of fractures that were internally fixed in the combat environment. The records of patients who had internal fixation performed in the theater of combat operations were reviewed. Demographics, injury characteristics, procedure history, and outcomes were recorded and analyzed. Forty-seven patients had internal fixation performed on 50 fractures in a combat theater hospital. Hip, forearm, and ankle fractures made up the majority of cases with 14 (28%), 14 (28%), and 10 (20%), respectively. Sixteen (32%) fractures were open. The average Injury Severity Score was 11.4 +/- 1.1 (range, 4-34). Thirty-nine fractures (78%) healed without incidence. There was one (2%) infection and one (2%) acute surgical complication. Ten (20%) fractures, including the one infection, required additional procedures. Because internal fixation in the combat environment was used judiciously, complications were not higher than previously reported.
authors.affiliation: Department of Regenerative Medicine, United States Army Institute of Surgical Research, 3400 Rawley E. Chambers Avenue, San Antonio, TX 78234, USA. daniel.stinner@amedd.army.mil
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Stinner
authors.forename: James A
authors.initials: JA
authors.lastname: Keeney
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Hsu
authors.forename: Jeremy K
authors.initials: JK
authors.lastname: Rush
authors.forename: Mickey S
authors.initials: MS
authors.lastname: Cho
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Wenke
authors.forename: James R
authors.initials: JR
authors.lastname: Ficke
mesh_terms: D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D054542:Iraq War, 2003-2011; D008887:Military Medicine; D016896:Treatment Outcome