OBJECTIVE
To describe medical care and surgical outcome after functional reconstructive surgery in late-presenting patients who already had at least one prior operation.

DESIGN
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.

SETTING
Médecins sans Frontières surgical programme in Jordan Red Crescent Hospital, Amman, Jordan.

PATIENTS
Sixty-two civilians with nonunion tibial fractures caused by war-related trauma in Iraq; 53 completed follow-up.

INTERVENTION
Amputation and/or reconstruction.

MAIN OUTCOME MEASUREMENTS
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.

Science Portal

Reconstruction of nonunion tibial fractures in war-wounded Iraqi civilians, 2006-2008: better late than never