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Wound ballistic during World War one Médecin en Chef RONGIERAS Hôpital DESGENETTES - Lyon.

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Presentation on theme: "Wound ballistic during World War one Médecin en Chef RONGIERAS Hôpital DESGENETTES - Lyon."— Presentation transcript:

1 Wound ballistic during World War one Médecin en Chef RONGIERAS Hôpital DESGENETTES - Lyon

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4 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

5 1- Osteo-articular wounds 1. Frequency 2. Causes 3. Caracteristics 4. Evolution 5. Severity

6 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

7 Artillery « Crapouillot » Torpedoes Grenades … Machine guns Rifles 2. Causes Shrapnels +++ Bullets n=20496 severely injured: (MIGNON) shells 882 grenades 1346 bullets 52 mines 12 blades 667 accidents

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9 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

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

11 3. Caracteristics Soft tissues injuries Bone lossComminution Severe Bone lesions

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14 Sauver et soigner à VERDUN 4-5 novembre Evolution Soft tissues INFECTION Gas Gangrene Contractures

15 Sauver et soigner à VERDUN 4-5 novembre Evolution Bone Osteitis, Fistulae Pseudarthrosis

16 Sauver et soigner à VERDUN 4-5 novembre Evolution Bone « Swinging » joint Ankylosis

17 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% †

18 2- Surgical treatment organization « La chirurgie d’expectante devient active, immédiate, préventive de l’infection »

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22 Forward stage: « Surgical centers for fractures » Stopovers: « Orthopaedic centers » Back line Hospital: « physiotherapy centers» « Center for patients with fractures »

23 « Surgical center for fractures »  wound treatment « Orthopaedic center »  Bone healing « Physiotherapy center»  Reeducation of recoverable patients Treatment support

24 3- First Aid Treatment 1. Disinfection 2. Immobilization

25 Sauver et soigner à VERDUN 4-5 novembre Disinfection Anti tetanus serum Sodium Hypochlorite 0,05% (DAKIN) Orders of Surgeon General CHAVASSE, oct 1915 Mass Casualties

26 Sauver et soigner à VERDUN 4-5 novembre 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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28 4- Forward surgery and back stage surgery

29 - International surgical conferences - Meeting between forward surgical teams and back stage surgical teams - Surgery Society of Paris 7 janvier 1918

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31 Forward surgical teams Diagnosis  X rays Treatments - Debridement - Disinfection - Wound closure? - Bony fixation

32 Bone debridement - « Esquillectomy » - Articular resection ‘‘ Enlever les fragments osseux libres, détachés, tombant dans la main.’‘ DELBET

33 Wound closure, skin closure - Primary closure - Delayed closure - Suture in successive times Duval, Tuffier Leriche Gaudier

34 Bone Stabilization Casts, splints « Emergency osteosynthesis » Duval, Rouvillois

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36 Second line hospitals - Radiology - Secondary closure - Bone stabilization Cast, traction, continuous extension, osteosynthesis

37 Carrel procedure - Disinfection - Bacteria count - Delayed closure

38 Traction DESFOSSES 1918

39 Continuous extension DELBET FINOCHIETTO De FOURMESTRAUX

40 Osteosynthesis Hanging (HEITZ-BOYER) Suture Bone Strapping

41 Osteosynthesis Plate External fixation LAMBOTTE

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44 Bone Graft Allograft Homograft Autograft ALBEEWALTHER Veal Bone Graft

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47 Articular Surgery Arthrodesis Joint resection LERICHE 1917

48 Sauver et soigner à VERDUN 4-5 novembre 2006 Physiotherapy…

49 Sauver et soigner à VERDUN 4-5 novembre 2006 Thank you… Acknowledgments Musée du Val de Grâce MCS Chauvin


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