Download - Wound ballistic during World War one Médecin en Chef RONGIERAS Hôpital DESGENETTES - Lyon
1. Osteo-articular
wounds
4. Forward bone surgery
and
definitive treatment
3. First aid treatment
2. Surgical treatment
organization
Wound Ballistic during World War One
• Mid and severe wounded• 600 à 700 per day (feb-june 1916 VERDUN)
• Limb wounds 60%
• Bone lesions 40%
1. Frequency
n=36620 (MIGNON)
N=10384 (27%) N=10620 (33%)
radiology
• Artillery• « Crapouillot »• Torpedoes• Grenades• …
• Machine guns• Rifles
2. Causes
Shrapnels +++
Bullets
n=20496 severely injured:(MIGNON)
17537 shells882 grenades1346 bullets
52 mines12 blades
667 accidents
• Vasculonervous lesionsLAPOINTE (oct 1914-feb1915 Ste Menehould, ambulance 8/2)
310 operated patients: 80 †
131 amputated patients: 39 †
DUVAL (Autochir 21) Articular wounds: 20% †
• Tendons lesions and cartilage lesions
Functionnal sequelae
5. Severity
35% †
2- Surgical treatment organization
« La chirurgie d’expectante devient active, immédiate, préventive de
l’infection »
• Forward stage:« Surgical centers for fractures »
• Stopovers:« Orthopaedic centers »
• Back line Hospital:« physiotherapy centers»
« Center for patients with fractures »
« Surgical center for fractures » wound treatment
« Orthopaedic center » Bone healing
« Physiotherapy center» Reeducation of recoverable patients
Treatment support
Sauver et soigner à VERDUN 4-5 novembre 2006
1. Disinfection
Anti tetanus serum
Sodium Hypochlorite 0,05%(DAKIN)
Orders of Surgeon General CHAVASSE, oct 1915
Mass Casualties
Sauver et soigner à VERDUN 4-5 novembre 2006
2. Immobilization, Splinting
‘‘Une immobilisation bien faite change complètement la situation d’un blessé, les douleurs cessent, les signes d’infection diminuent, la confiance dans la guérison se fortifie…’’ MIGNON
1917
- International surgical conferences- Meeting between forward surgical teams and back stage surgical teams- Surgery Society of Paris
7 janvier 1918
Forward surgical teams
Diagnosis X rays
Treatments- Debridement- Disinfection- Wound closure?- Bony fixation
Bone debridement
- « Esquillectomy »
- Articular resection
‘‘ Enlever les fragments osseux libres, détachés, tombant dans la main.’‘DELBET
Wound closure, skin closure
- Primary closure
- Delayed closure
- Suture in successive times
Duval, Tuffier
Leriche
Gaudier
Second line hospitals
- Radiology
- Secondary closure
- Bone stabilizationCast, traction, continuous extension, osteosynthesis