title: Reconstruction of nonunion tibial fractures in war-wounded Iraqi civilians, 2006-2008: better late than never.
abstract: OBJECTIVE
  To describe medical care and surgical outcome after functional reconstructive surgery in late-presenting patients who already had at least one prior operation.
  
  
  METHODS
  Retrospective review of medical care and surgical outcome from August 2006 to December 2008 using patient records for initial data with active follow-up for the latest outcome information.
  
  
  METHODS
  Médecins sans Frontières surgical programme in Jordan Red Crescent Hospital, Amman, Jordan.
  
  
  METHODS
  Sixty-two civilians with nonunion tibial fractures caused by war-related trauma in Iraq; 53 completed follow-up.
  
  
  METHODS
  Amputation and/or reconstruction.
  
  
  METHODS
  Late surgical complications (after the patient's return to Iraq) were analyzed for infection recurrence, bone union, and functional condition (defined using the Short Musculoskeletal Functional Assessment score).
  
  
  RESULTS
  Almost three fourths of patients arrived with infected injuries, 9 of whom had amputation as the initial surgery; the rest, and all uninfected patients, had reconstruction. Excluding loss to follow-up, only 4 of 53 (8%) patients who arrived with an infected injury had infection recurrence. Excluding loss to follow-up and amputation, 2 of 14 (14%) patients in the uninfected and 5 of 30 (17%) in the infected injury group did not achieve successful tibial union. Mean Dysfunctional and Bothersome Indices overall were 27.1 and 29.8, respectively, with similar results for all 3 groups (amputations, uninfected, and infected injuries).
  
  
  CONCLUSIONS
  Our study shows that patients with infected and uninfected injuries surgically treated in Amman achieved similar outcomes. Despite late presentation, our patients had a comparable outcome to other studies dealing with early reconstruction. Reconstruction for the infected group required longer treatment time.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Médecins sans Frontières, Paris, France.
authors.forename: Rasheed M
authors.initials: RM
authors.lastname: Fakri
authors.forename: Ali M K
authors.initials: AM
authors.lastname: Al Ani
authors.forename: Angela M C
authors.initials: AM
authors.lastname: Rose
authors.forename: Majd S
authors.initials: MS
authors.lastname: Alras
authors.forename: Laurent
authors.initials: L
authors.lastname: Daumas
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Baron
authors.forename: Sinan
authors.initials: S
authors.lastname: Khaddaj
authors.forename: Patrick
authors.initials: P
authors.lastname: Hérard
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D007493:Iraq; D054542:Iraq War, 2003-2011; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000601:surgery*; D055815:Young Adult