INTRODUCTION Tibial bone gaps after war injuries are common and can be managed by different types of surgery, including compression, bone graft, tibialisation of fibula, bone transport, and free flaps. Here, we present an algorithm developed at a humanitarian surgical hospital to manage tibial bone gaps. We also identify some key factors affecting patient outcomes and describe some clinical considerations for choosing treatment strategy. METHOD We performed retrospective data analysis on war-wounded adult patients with tibial injuries treated at our project according to the described algorithm. Patient outcomes were followed for at least four years. Outcomes assessed were length of stay, complication rate, re-admission (late complications), and final discharge. RESULTS Among the 200 included patients, 103 (51.5%) had bone gaps. Univariate analysis showed that the presence of a bone gap, but not its size, was associated with significantly increased risk of early complications, while type of surgery was significantly correlated with re-admission. Presence of a bone gap and type of surgery were each significantly associated with length of stay. Bone gap size showed no correlation with outcomes, an unexpected finding. DISCUSSION Soft tissue damage with compromised vascularity may explain the lack of association between bone gap size and outcomes. Specialised centres using standardised approaches to complex surgical reconstruction can play an important role in expanding the evidence base needed to improve case management. CONCLUSIONS Less invasive procedures may lead to better patient outcomes, although unfortunately may not always be possible given the nature of the injury and/or injury site.

中文翻译：

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顺序治疗中东战伤患者骨干间隙的决策算法。

引言战伤后的胫骨骨间隙很常见，可以通过不同类型的手术来处理，包括加压，植骨，腓骨胫骨化，骨运输和游离皮瓣。在这里，我们介绍一种在人道主义外科医院开发的用于管理胫骨骨间隙的算法。我们还确定了影响患者预后的一些关键因素，并描述了选择治疗策略的一些临床考虑。方法我们根据描述的算法，对在我们的项目中接受治疗的战伤成人胫骨受伤患者进行了回顾性数据分析。随访患者至少四年。评估的结果为住院时间，并发症发生率，再次入院（晚期并发症）和最终出院。结果在200例患者中，有103例（51.5％）患有骨间隙。单因素分析表明，存在骨间隙而不是其大小与早期并发症的风险显着增加相关，而手术类型与再次入院显着相关。骨间隙的存在和手术类型均与住院时间显着相关。骨间隙大小与预后无关，这是一个意外的发现。讨论软组织损伤和血管受损可能解释了骨间隙大小与预后之间缺乏关联。使用标准化方法进行复杂外科手术重建的专业中心可以在扩大改善病例管理所需的证据基础方面发挥重要作用。结论侵入性较小的手术可能会导致更好的患者预后，