Defektschußbrüche des Oberarms und ihre Behandlung unter schwierigen Bedingungen Drei Fallberichte aus Provinzhospitälern Äthiopiens und Somalias

Gunshot fractures of the extremities often result in large bone defects and disability. The reconstruction of the bone is the essential precondition for a successful rehabilitation. This is a report on three patients who suffered from substantial bone defects of the humerus shaft caused by high-velocity bullets. In one patient the injury happened 3 days before admission, in another patient 5 months before. The third patient had a history of 11 years since the injury with numerous operations, bone grafts included. He presented with an infected non-union. All three patients had a complete radial nerve paralysis right from the beginning, as they have reported. Debridement, sequestrectomy and immobilisation by an external fixator with a device for compression and distraction were the first steps in management, followed by slow compression and, after a free interval, by distraction for 1 mm per day over a period of ca. 4 weeks. After distraction, one patient had early spontaneous callus formation. Two patients received a spongious bone graft, and in one of them decompression of the radial nerve was carried out during the operation for bone grafting. Subsequently, all three patients showed good callus formation. When strong ossification was visible on the X-rays, the fixator was removed and a PoP brace applied. The change from the external fixator to an internal fixation by a plate was not necessary and, under the prevailing conditions, not even possible. The patients were discharged with the brace and encouraged to continue with exercises. When the patients came back for a follow-up examination, the fracture sites were stable and the bones showed good consolidation. In two cases, the function of the radial nerve was nearly completely restored, in the patient with the long history, of course, there was no change. All three patients were free of infection. These three cases show that, even under the unfavourable conditions of civil war and in hospitals of less prosperous countries, the treatment of large bone defects can be successful, provided material and sometimes personnel support is, if necessary, given to the hospitals dealing with war and accident victims.