Emergency War Surgery NATO Handbook: Part III: General Considerations of Wound Management: Chapter XIX: Wounds and Injuries of Bones and Joints

Introduction

United States Department of Defense

The frequency of extremity injuries in combat invariably generates significant numbers of bone and joint injuries. These injuries may be closed (simple) but are usually open (compound). Closed injuries are treated as they might be under other conditions, with the exception that elective surgical procedures should not be performed in forward medical facilities. The management of the open injury begins exactly as for open soft-tissue injuries (Chapter XVI). The immediate objectives in the treatment of these injuries are the preservation of neurovascular function and the prevention of infection. Complete wound healing and return to full function constitute the long-term goals. Staged wound management consisting of thorough debridement and delayed wound closure will convert an open injury to a closed injury in a high percentage of cases. Historically, failure to adhere to this basic principle of management has consistently yielded an unacceptably high incidence of infection and has frequently resulted in catastrophic functional loss.

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Operational Medicine 2001

Health Care in Military Settings

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