Journal Article > ReviewAbstract
Int Orthop. 2013 May 12; Volume 37 (Issue 8); DOI:10.1007/s00264-013-1904-7
Herard P, Boillot F
Int Orthop. 2013 May 12; Volume 37 (Issue 8); DOI:10.1007/s00264-013-1904-7
Journal Article > ResearchFull Text
Int Orthop. 2014 July 20; Volume 38 (Issue 8); 1555-1561.; DOI:10.1007/s00264-014-2451-6
Bertol MJ, Van der Bergh R, Trelles M, Kenslor H, Basimuoneye JP, et al.
Int Orthop. 2014 July 20; Volume 38 (Issue 8); 1555-1561.; DOI:10.1007/s00264-014-2451-6
PURPOSE
While the orthopaedic management of open fractures has been well-documented in developed settings, limited evidence exists on the surgical outcomes of open fractures in terms of limb salvage in low- and middle-income countries. We therefore reviewed the Médecins Sans Frontières-Operational Centre Brussels (MSF-OCB) orthopaedic surgical activities in the aftermath of the 2010 Haiti earthquake and in three non-emergency projects to assess the limb salvage rates in humanitarian contexts in relation to surgical staff skills.
METHODS
This was a descriptive retrospective cohort study conducted in the MSF-OCB surgical programmes in the Democratic Republic of Congo (DRC), Afghanistan, and Haiti. Routine programme data on surgical procedures were aggregated and analysed through summary statistics.
RESULTS
In the emergency post-earthquake response in Haiti, 81% of open fracture cases were treated by amputation. In a non-emergency project in a conflict setting in DRC, relying on non-specialist surgeons receiving on-site supervision and training by experienced orthopaedic surgeons, amputation rates among open fractures decreased by 100 to 21% over seven years of operations. In two trauma centres in Afghanistan (national surgical staff supported from the outset by expatriate orthopaedic surgeons) and Haiti (national musculoskeletal surgeons trained in external fixation), amputation rates among long bone open fracture cases were stable at 20% and <10%, respectively.
CONCLUSIONS
Introduction of and training on the proper use of external fixators reduced the amputation rate for open fractures and consequently increased the limb salvage rates in humanitarian contexts where surgical care was provided.
While the orthopaedic management of open fractures has been well-documented in developed settings, limited evidence exists on the surgical outcomes of open fractures in terms of limb salvage in low- and middle-income countries. We therefore reviewed the Médecins Sans Frontières-Operational Centre Brussels (MSF-OCB) orthopaedic surgical activities in the aftermath of the 2010 Haiti earthquake and in three non-emergency projects to assess the limb salvage rates in humanitarian contexts in relation to surgical staff skills.
METHODS
This was a descriptive retrospective cohort study conducted in the MSF-OCB surgical programmes in the Democratic Republic of Congo (DRC), Afghanistan, and Haiti. Routine programme data on surgical procedures were aggregated and analysed through summary statistics.
RESULTS
In the emergency post-earthquake response in Haiti, 81% of open fracture cases were treated by amputation. In a non-emergency project in a conflict setting in DRC, relying on non-specialist surgeons receiving on-site supervision and training by experienced orthopaedic surgeons, amputation rates among open fractures decreased by 100 to 21% over seven years of operations. In two trauma centres in Afghanistan (national surgical staff supported from the outset by expatriate orthopaedic surgeons) and Haiti (national musculoskeletal surgeons trained in external fixation), amputation rates among long bone open fracture cases were stable at 20% and <10%, respectively.
CONCLUSIONS
Introduction of and training on the proper use of external fixators reduced the amputation rate for open fractures and consequently increased the limb salvage rates in humanitarian contexts where surgical care was provided.
Journal Article > CommentaryAbstract
Quality orthopaedic care in sudden-onset disasters: suggestions from Médecins Sans Frontières-France
Int Orthop. 2015 November 28
Herard P, Boillot F
Int Orthop. 2015 November 28
Journal Article > EditorialFull Text
Int Orthop. 2024 January 11; Online ahead of print (Issue 2); 323-330.; DOI:10.1007/s00264-024-06089-5
Hernigou P, Homma Y, Herard P, Scarlat MM
Int Orthop. 2024 January 11; Online ahead of print (Issue 2); 323-330.; DOI:10.1007/s00264-024-06089-5
Journal Article > ReviewFull Text
Int Orthop. 2015 May 15; Volume 39 (Issue 10); DOI:10.1007/s00264-015-2781-z
Alvarado O, Trelles M, Tayler-Smith K, Joseph H, Gesline R, et al.
Int Orthop. 2015 May 15; Volume 39 (Issue 10); DOI:10.1007/s00264-015-2781-z
Journal Article > ResearchAbstract Only
Int Orthop. 2019 February 23; Volume 43 (Issue 12); 2653-2659.; DOI:10.1007/s00264-019-04317-x
Fakhri RM, Herard P, Liswi MI, Boulart AL, Al Ani AM
Int Orthop. 2019 February 23; Volume 43 (Issue 12); 2653-2659.; DOI:10.1007/s00264-019-04317-x
INTRODUCTION
Tibial bone gaps after war injuries are common and can be managed by different types of surgery, including compression, bone graft, tibialisation of fibula, bone transport, and free flaps. Here, we present an algorithm developed at a humanitarian surgical hospital to manage tibial bone gaps. We also identify some key factors affecting patient outcomes and describe some clinical considerations for choosing treatment strategy.
METHOD
We performed retrospective data analysis on war-wounded adult patients with tibial injuries treated at our project according to the described algorithm. Patient outcomes were followed for at least four years. Outcomes assessed were length of stay, complication rate, re-admission (late complications), and final discharge.
RESULTS
Among the 200 included patients, 103 (51.5%) had bone gaps. Univariate analysis showed that the presence of a bone gap, but not its size, was associated with significantly increased risk of early complications, while type of surgery was significantly correlated with re-admission. Presence of a bone gap and type of surgery were each significantly associated with length of stay. Bone gap size showed no correlation with outcomes, an unexpected finding.
DISCUSSION
Soft tissue damage with compromised vascularity may explain the lack of association between bone gap size and outcomes. Specialised centres using standardised approaches to complex surgical reconstruction can play an important role in expanding the evidence base needed to improve case management.
Tibial bone gaps after war injuries are common and can be managed by different types of surgery, including compression, bone graft, tibialisation of fibula, bone transport, and free flaps. Here, we present an algorithm developed at a humanitarian surgical hospital to manage tibial bone gaps. We also identify some key factors affecting patient outcomes and describe some clinical considerations for choosing treatment strategy.
METHOD
We performed retrospective data analysis on war-wounded adult patients with tibial injuries treated at our project according to the described algorithm. Patient outcomes were followed for at least four years. Outcomes assessed were length of stay, complication rate, re-admission (late complications), and final discharge.
RESULTS
Among the 200 included patients, 103 (51.5%) had bone gaps. Univariate analysis showed that the presence of a bone gap, but not its size, was associated with significantly increased risk of early complications, while type of surgery was significantly correlated with re-admission. Presence of a bone gap and type of surgery were each significantly associated with length of stay. Bone gap size showed no correlation with outcomes, an unexpected finding.
DISCUSSION
Soft tissue damage with compromised vascularity may explain the lack of association between bone gap size and outcomes. Specialised centres using standardised approaches to complex surgical reconstruction can play an important role in expanding the evidence base needed to improve case management.
Journal Article > CommentaryFull Text
Int Orthop. 2012 May 15; Volume 36 (Issue 10); 1979-1981.; DOI:10.1007/s00264-012-1552-3
Herard P, Boillot F
Int Orthop. 2012 May 15; Volume 36 (Issue 10); 1979-1981.; DOI:10.1007/s00264-012-1552-3
PURPOSE
The decision to amputate is always difficult but becomes even harder in emergency situations, which usually present extra complicating factors.
MSF EXPERIENCE
These include human factors (related to both the surgeon and the patient); poor or nonexistent medical facilities, especially in war conditions or resource-poor countries; and cultural and religious considerations. Médecins Sans Frontières (MSF) has developed a quick medical and logistical response that relies on surgical protocols adapted to emergency situations, together with complete "kits" of medical equipment, supplies and inflatable facilities.
CONCLUSION
Our response to Haiti's 2010 earthquake relied on these tools but also highlighted the need to develop more detailed protocols that will help our teams on the ground.
The decision to amputate is always difficult but becomes even harder in emergency situations, which usually present extra complicating factors.
MSF EXPERIENCE
These include human factors (related to both the surgeon and the patient); poor or nonexistent medical facilities, especially in war conditions or resource-poor countries; and cultural and religious considerations. Médecins Sans Frontières (MSF) has developed a quick medical and logistical response that relies on surgical protocols adapted to emergency situations, together with complete "kits" of medical equipment, supplies and inflatable facilities.
CONCLUSION
Our response to Haiti's 2010 earthquake relied on these tools but also highlighted the need to develop more detailed protocols that will help our teams on the ground.
Journal Article > ResearchFull Text
Int Orthop. 2014 May 10; Volume 38 (Issue 8); 1551-1554.; DOI:10.1007/s00264-014-2344-8
Boillot F, Herard P
Int Orthop. 2014 May 10; Volume 38 (Issue 8); 1551-1554.; DOI:10.1007/s00264-014-2344-8
PURPOSE
Carrying out osteosynthesis is challenging, and controlling for results and complications is necessary to define the limits of acceptable complications. Within the context of sudden-onset disasters, comparing internal with external osteosynthesis remains controversial.
METHODS
The most recent and significant Médecins Sans Frontières (MSF) experience with osteosynthesis was following the earthquake in Haiti in 2010: 353 external fixators were used in the 12 months following the catastrophe, 62 of which were used in the first month. Carrying out internal osteosynthesis was possible two weeks following the earthquake.
RESULTS
The most common indication for open tibial fracture was Gustillo grade 2 or 3. Conversion rate from external to internal osteosynthesis remains anecdotal for several practical reasons. Advantages and drawbacks of external fixators are discussed in the context of precarious situations frequently encountered by MSF.
CONCLUSIONS
External osteosynthesis as a primary and definitive treatment for open fractures, especially of the leg, remains the most frequently used and best-adapted procedure in the context of sudden-onset disasters, even though not ideal.
Carrying out osteosynthesis is challenging, and controlling for results and complications is necessary to define the limits of acceptable complications. Within the context of sudden-onset disasters, comparing internal with external osteosynthesis remains controversial.
METHODS
The most recent and significant Médecins Sans Frontières (MSF) experience with osteosynthesis was following the earthquake in Haiti in 2010: 353 external fixators were used in the 12 months following the catastrophe, 62 of which were used in the first month. Carrying out internal osteosynthesis was possible two weeks following the earthquake.
RESULTS
The most common indication for open tibial fracture was Gustillo grade 2 or 3. Conversion rate from external to internal osteosynthesis remains anecdotal for several practical reasons. Advantages and drawbacks of external fixators are discussed in the context of precarious situations frequently encountered by MSF.
CONCLUSIONS
External osteosynthesis as a primary and definitive treatment for open fractures, especially of the leg, remains the most frequently used and best-adapted procedure in the context of sudden-onset disasters, even though not ideal.