Management of Missile Injuries of the Knee

Abstract

Background and Objectives: Iraq continues to be a troublesome area, missile injuries around the large joints of the extremity remains to be a challenging injury to the under resourced and poorly equipped unsafe hospitals. The aim of this study is to report our experience in the management of such injuries. patients and methods: Thirteen patients (14 knees) with grade III Gustillo open fractures of the knee caused by war injury including bullets, shells of blast and missiles were treated by wound debridement, washout, repair of arterial injury after external or internal fixation of the fracture. Five patients (38%) required Dacron arterial graft for associated vascular injury, there was a case of permanent nerve damage (7%). Results: The outcome was satisfactory in 6 patients (46%), fair in five (38%) and poor in the remaining (16%). One limb remained was ischemic; one case of infection required amputation. These patients underwent wound debridement, skeletal fixation and vascular and or plastic reconstruction. Conclusion: There is high association of open war injuries of the knee with neurovascular injuries. Awareness of the associated vascular injury and team approach, is vital in the management of these injuries. Skeletal stabilization using any method deem to be appropriate is associated with good outcome provided appropriate early wound debridement is performed.