SIMPLIFIED EXTERNAL FIXATION FOR PRIMARY MANAGEMENT OF SEVERE MUSCULOSKELETAL INJURIES UNDER WAR AND PEACE TIME CONDITIONS

This study was undertaken to document whether a basic set of a new uni lateral external fixation device could provide sufficient stability in complex musculoskeletal injuries involving upper and lower extremitie s and in patients with unstable pelvic ring disruptions. The initial c linical evaluation was performed in Sweden (stage 1) followed by field evaluation at the Swedish Field Hospital during the Mogadishu conflic t in Somalia (stage 2). In stage 1, there were 90 patients with 116 ac ute limb injuries and six patients with an unstable pelvic ring disrup tion. Ninety limb injuries and all six pelvic fractures were primarily stabilized by the external fixation device. The other 26 fractures we re managed at the index operation with intramedullary nailing, open re duction, and internal fixation or cast immobilization. Twelve patients had a local pedicle or free vascularized flap for soft tissue coverag e. One multiply injured with an open Gustilo IIIB tibial shaft fractur e had an early amputation. The basic set provided adequate stabilizati on for soft tissue recovery in 89 limb injuries (89 of 90), thereby pr oviding optimal conditions for continued management to skeletal consol idation in ss patients. Hemodynamic stabilization was achieved in all six patients with unstable pelvic fractures. In stage 2, there were 63 patients with war injuries and 33 patients injured in traffic acciden ts. All were managed under field conditions. The basic set was suffici ent for soft tissue recovery in all 96 cases. It is concluded that the rigidity of this device is adequate for stabilization of severe muscu loskeletal injuries requiring major surgical procedures. In addition, the simplicity of this device, which allows for only a limited number of possible configurations makes it suitable for inexperienced surgeon s working under war or mass-casualty conditions to manage these comple x musculoskeletal injuries.