Orthopedic Surgery in the Mediterranean Theater of Operations

This book gives a complete and comprehensive study of the combat-incurred injuries in the Mediterranean Theater (previously North African Theater) from November 8, 1942 to May 2, 1945. The studies which were carried out over this period produced changes in the concepts and methods of treatment -of severe, compound, soft tissue and skeletal injuries. They are briefly as follows: In the early period of the war the concept of treatment was plasma for shock, sulfanilimide drug for the prevention of infection, and the closed plaster (Trueta) management for fractures and soft tissue wounds. In the latter part of 1943 the management of these severe wounds was divided into four phases. The first phase being that of first aid which consisted of the arrest of hemorrhage, plasma, morphine, sterile dressings, and splinting of the part. The second phase consisted of the initial surgery at the forward hospital. It was here that resuscitation, whole blood transfusions, adequate initial debridement of the wounds, and dressing of the wounds with fine mesh gauze and splinting with plaster casts was instituted. The objectives at this stage were to save life, limbs, and to prevent infection. Fresh wounds were operated on as soon as possible and the patient transferred to a fixed hospital 24 to 48 hours later. In phase three it was found that seven to ten days' post-wounding was the optimum time to carry out preparative surgery. This consisted of wound revision, of further debridement, closure of the wound, and fracture reduction by manipulation and plaster or skeletal traction immobilization. Internal fixation was employed only in special circumstances. It is interesting to note that the largest percentage of failures resulted from plating of tibial fractures. Dependent drainage with drains removed 3 to 10 days later was instituted in the majority of compounded wounds and fractures. It was here that dirty wounds were converted to clean fresh wounds by secondary excisional surgery and drainage of closed spaces. Phase four consisted of the reconstruction procedures for the zone of interior hospitals. Dr. Hampton has shown conclusively that the most important consideration of the management of compound fractures and wounds of joints in time of war was that of sound basic surgical principles. A considerable period of time has elapsed since 1945 and our knowledge of antibiotic therapy, electrolyte and fluid balances, as well as new methods of internal fixation of fractures, has increased profoundly. Nevertheless, if and when we encounter mass casualties, the basic principles which were learned in this war should not be forgotten. LELAND LUGAR