The Damage Control Orthopedics and External Fixation in traffic accident after 20 Years in the Bosnian War: Our Experience and a Review of the Literature

Introduction: The Damage Control Orthopedics (DCO) with external fixation is the most valuable aid for a surgeon, when a quick and efficient solution to war and civil injuries to the extremities and pelvis is needed. Material and methods: 2462 wounded patients were analyzed in this study. These patients sustained injuries to the extremities, abdomen, thorax and head, and received primary surgical treatment at the Orthopedics and Traumatology Clinic in Banja Luka in the period between September 15, 1991 and December 1, 1995. Out of the 2462 patients, 122 (4.59%) were women, 24 (0.9%) were children and 2269 (94.15%) were men. The average age of the patients was 33.73 years. 265 (10.77%) sustained muscular and cutaneous injuries to the extremities without bone fractures, and 2197 (89.23%) had broken bone fragments that required stabilization after the primary surgical treatment. Out of the 2197 patients with broken bones, 2043 (92.43%) sustained comminuted fractures with or without bone defects. In 1573 patients (72%) broken bone fragments were primarily stabilized with external fixators, and in 531(24%) with plaster casts and plaster casts combined with Steinmann pins and Kirschner wires. In 91 (4%) extensions were used. This retrospective study shows how to primarily treat the injured extremities, with and without fractures, as well as how to select the method for stabilizing fractured bones. During the period between January 1,2009 and December 31,2013, reveals the method used to treat 658 traffic accidents with injured extremities, who received primary treatment at Banja Luka Clinical Centre. Out of the 658 wounded people, 98 (14.90%) were women, and (94.15%) were men. The oldest wounded woman was 58 years old, the oldest man was 67. The average age of the wounded people was 24.31. In the emergency room we treated 596 (160 open fractures) patients with external fixation for DCO and only 62 patients with Trans-Skeletal Traction when we had problem in trauma team like anesthetists busy with other critically ill patients.