[Reconstructive surgery in war injuries of the bones and joints]

The basic problems of bone-and-joint surgery with special emphasis on war injuries and the role of reconstructive surgery in relieving the gravest consequences of war injuries are discussed. Since bone and joint injuries rank high among the war injuries with a share of over 70% including more than 30% of fractures, they pose not only a serious medical and surgical but also a major public health problem. The economic and social consequences of these injuries are further aggravated by the necessity for prolonged treatment and multiple surgical interventions. The basic preconditions which must be fulfilled for bone healing to take place are discussed in the light of the ultimate goal of all therapeutic efforts. i.e. restoration of full functional ability of the injured extremity. The importance of bone fragment immobilization for the process of bone healing is emphasized. Impaired bone healing, resulting from insufficient immobilization or inadequate reposition of bone fragments, is a common problem with war fractures, mainly because of the great forces involved and extensive destruction of bone and all other surrounding tissues. One of the main features of war fractures is delayed bone healing caused by massive circulatory defects in the injured bone. Some special problems attending war injuries, such as pseudarthroses and associated defects, soft tissue infections and defects, may only be effectively solved by cooperation with a plastic-vascular- or neurosurgeon. In one and joint surgery profound understanding of the physiology, pathophysiology and biomechanics of bone healing, knowledge of modern methods of osteosynthesis, skill in the management of bone and other infections as well as knowledge of the latest developments in postoperative care are essential for achieving satisfactory therapeutic results. Availability of various implants and a wide range of surgical instruments is a precondition which needs no further discussion. It is only in this way that the most promising course of action can be selected for each wounded person individually, a course of action which will, in the shortest possible time and the most convenient manner, lead to the desired therapeutic goal, i.e. restoration of satisfactory bone and joint function.