Wound ballistic during World War one

Médecin en Chef RONGIERASHôpital 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

1- Osteo-articular wounds

1. Frequency2. Causes3. Caracteristics4. Evolution5. Severity

• 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

LEBEL 1886/93Cal. 8 mm, lenght 1305 mm, weight 4180g, 8 cartridges

3. Caracteristics

Soft tissues injuries

Bone lossComminution

Severe Bone lesions

4. Evolution

Soft tissues

INFECTION

Gas Gangrene

Contractures

4. Evolution

Bone

Osteitis, Fistulae

Pseudarthrosis

4. Evolution

Bone

« Swinging » joint

Ankylosis

• 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

3- First Aid Treatment

1. Disinfection

2. Immobilization

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

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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

4- Forward surgery and back stage surgery

- 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

Bone Stabilization

Casts, splints

« Emergency osteosynthesis » Duval, Rouvillois

Second line hospitals

- Radiology

- Secondary closure

- Bone stabilizationCast, traction, continuous extension, osteosynthesis

Carrel procedure

- Disinfection- Bacteria count- Delayed closure

Traction

DESFOSSES 1918

Continuous extension

DELBET

DELBETFINOCHIETTO

De FOURMESTRAUX

Osteosynthesis

Hanging (HEITZ-BOYER)

Suture

Bone Strapping

Osteosynthesis

Plate

External fixation

LAMBOTTE

Bone Graft

AllograftHomograftAutograft

ALBEEWALTHER Veal Bone Graft

Articular Surgery

ArthrodesisJoint resection

LERICHE 1917

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Physiotherapy…

Sauver et soigner à VERDUN 4-5 novembre 2006

Thank you…

Acknowledgments

Musée du Val de GrâceMCS Chauvin