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Wound ballistic during World War one Médecin en Chef RONGIERAS Hôpital DESGENETTES - Lyon
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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
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1- Osteo-articular wounds 1. Frequency 2. Causes 3. Caracteristics 4. Evolution 5. Severity
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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
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Artillery « Crapouillot » Torpedoes Grenades … Machine guns Rifles 2. Causes Shrapnels +++ Bullets n=20496 severely injured: (MIGNON) 17537 shells 882 grenades 1346 bullets 52 mines 12 blades 667 accidents
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1 La blessure ostéoarticulaire 2 Organisation du traitement chirurgical 3 Prise en charge au poste de secours4 Chirurgie osseuse en 1ère ligne et à l’arrière
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LEBEL 1886/93 Cal. 8 mm, lenght 1305 mm, weight 4180g, 8 cartridges
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3. Caracteristics Soft tissues injuries Bone lossComminution Severe Bone lesions
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Sauver et soigner à VERDUN 4-5 novembre 2006 4. Evolution Soft tissues INFECTION Gas Gangrene Contractures
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Sauver et soigner à VERDUN 4-5 novembre 2006 4. Evolution Bone Osteitis, Fistulae Pseudarthrosis
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Sauver et soigner à VERDUN 4-5 novembre 2006 4. Evolution Bone « Swinging » joint Ankylosis
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Vasculonervous lesions LAPOINTE (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% †
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2- Surgical treatment organization « La chirurgie d’expectante devient active, immédiate, préventive de l’infection »
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Forward stage: « Surgical centers for fractures » Stopovers: « Orthopaedic centers » Back line Hospital: « physiotherapy centers» « Center for patients with fractures »
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« Surgical center for fractures » wound treatment « Orthopaedic center » Bone healing « Physiotherapy center» Reeducation of recoverable patients Treatment support
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3- First Aid Treatment 1. Disinfection 2. Immobilization
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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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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
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4- Forward surgery and back stage surgery
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- International surgical conferences - Meeting between forward surgical teams and back stage surgical teams - Surgery Society of Paris 7 janvier 1918
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Forward surgical teams Diagnosis X rays Treatments - Debridement - Disinfection - Wound closure? - Bony fixation
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Bone debridement - « Esquillectomy » - Articular resection ‘‘ Enlever les fragments osseux libres, détachés, tombant dans la main.’‘ DELBET
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Wound closure, skin closure - Primary closure - Delayed closure - Suture in successive times Duval, Tuffier Leriche Gaudier
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Bone Stabilization Casts, splints « Emergency osteosynthesis » Duval, Rouvillois
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Second line hospitals - Radiology - Secondary closure - Bone stabilization Cast, traction, continuous extension, osteosynthesis
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Carrel procedure - Disinfection - Bacteria count - Delayed closure
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Traction DESFOSSES 1918
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Continuous extension DELBET FINOCHIETTO De FOURMESTRAUX
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Osteosynthesis Hanging (HEITZ-BOYER) Suture Bone Strapping
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Osteosynthesis Plate External fixation LAMBOTTE
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Bone Graft Allograft Homograft Autograft ALBEEWALTHER Veal Bone Graft
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Articular Surgery Arthrodesis Joint resection LERICHE 1917
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Sauver et soigner à VERDUN 4-5 novembre 2006 Physiotherapy…
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Sauver et soigner à VERDUN 4-5 novembre 2006 Thank you… Acknowledgments Musée du Val de Grâce MCS Chauvin
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