Severe Injuries to the Limbs

Modern weapons and high-energy accidents inflict devastating damage to soft tissue and bone. This book details the protocol of staged external fixation developed by the authors: primary temporary unilateral tubular stabilization followed by definitive circular Ilizarov (hybrid) fixation. The text is based on the vast experience of the Rambam Medical Center in Haifa, Israel. Coverage explains and fully illustrates the rationale and advantages of a logical progression of surgical steps. The book draws from an archive of clinical photographs and X-ray documentation that cover all steps in a large variety of complex cases, including extensive bone and soft tissue loss.

Introduction: Statistics.- Epidemiology. Etiology and pathogenesis.- Missile injuries.- Explosive - Blast - Crush injuries. Classification according to extent of bone and soft tissue loss. Primary treatment and 'damage control': Tissue debridement of high-energy injuries.- Primary skeletal stabilization (unilateral external fixation frames, hybrid frames, temporary articular bridging).- Soft-tissue protection by external fixation frames.- Vascular reconstruction. Soft-tissue coverage (delayed primary suture, skin and local tissue flaps, free tissue flaps). Definitive skeletal reconstruction: Ilizarov circular fixation.- Hybrid frames (variations in modular combination between different types of external fixation devices).- Hinged fixation of peri-articular injuries.- Peculiarity of the elbow joint reconstruction: methods of isolated hybrid external fixation of humeral, ulnar and radial bones.- Arthrodesis in extensive joint destruction. Limb salvage in severe bone and soft tissue loss: Bone reconstruction by callotasis and bone transport.- Acute shortening.- Acute shortening and angulation. Post-traumatic infection: Soft tissue.- Bone. Early functional rehabilitation, especially in peri-articular injuries: Active and passive joint mobilization in external frames.- Weight bearing.- Tactics in bilateral lower limb injuries, including one-sided limb loss. Algorithms and conclusions.

"...In this book, the authors make an eloquent plea for extensive use of external fixator technology to avoid secondary injury to extremities when fractures include significant soft tissue injury. While the damage control specialist will treasure this book for the quality of illustrations alone, the orthopedist treating war or terrorism injuries may benefit from the perspectives presented here." (D.J. Dries, University of Minnesota Medical School, Doody's)