INTRODUCTION Treatment of war wounds is based on a sequential surgical strategy, which frequently faces therapeutic failures, which then burden the final functional result. The aim of this study was to identify risk factors of failure of the different treatments to prevent the therapeutic failure. METHODS A monocentric case-control study was done on French war-wounded soldiers treated for an open fracture caused by an invasive war weapon. The primary end point was the treatment failure three months after the injury. The risk factors of failure studied were the traumatic mechanism, the general and local lesional assessment, and the surgery performed. RESULTS Between January 1, 2004 and December 31, 2016, 57 soldiers were included, with an average follow-up of 3.42 years. On 81 limb segments studied, the most injured segment was the leg (37.0%). A vital or urgent surgery requirement (OR = 1.56; p = 0.02) and bone loss substance (OR = 5.45; CI95% = 1.54-20.09) were risk factors of failure for limb salvage treatment. Improvised explosive device traumatic mechanism (OR = 1.56; p = 0.02) and the persistence of surgical site contamination after two debridement procedures (OR = 1.20; p = 0.04) were risk factors of failure for amputation procedures. CONCLUSIONS Two main risk factors of treatment failure are highlighted: those in relation to traumatic mechanisms and general lesional assessment and those in relation to surgical site conditions. There is no over risk of failure in relation to surgical procedure and treatment.

中文翻译：

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战斗伤亡中肢体受伤管理的风险因素和失败。

引言战伤的治疗基于顺序手术策略，该策略经常面临治疗失败，继而负担最终的功能结果。这项研究的目的是确定不同治疗失败的危险因素，以预防治疗失败。方法对接受过治疗的法国战伤士兵进行单中心病例对照研究，研究该伤员是由于侵略性战争武器造成的开放性骨折。主要终点是受伤后三个月的治疗失败。研究失败的危险因素是外伤机制，总体和局部病变评估以及所进行的手术。结果2004年1月1日至2016年12月31日，共纳入57名士兵，平均随访3.42年。在研究的81个肢体节段中，受伤最多的段是腿（37.0％）。至关重要的或紧急的手术要求（OR = 1.56； p = 0.02）和骨质流失物质（OR = 5.45； CI95％= 1.54-20.09）是肢体抢救治疗失败的危险因素。简易的爆炸装置创伤机制（OR = 1.56； p = 0.02）和两次清创术后手术部位污染的持续存在（OR = 1.20； p = 0.04）是截肢手术失败的危险因素。结论强调了治疗失败的两个主要危险因素：与创伤机制和一般病变评估有关的因素以及与手术部位情况有关的因素。在外科手术和治疗方面，没有过度失败的风险。简易的爆炸装置创伤机制（OR = 1.56； p = 0.02）和两次清创术后手术部位污染的持续存在（OR = 1.20； p = 0.04）是截肢手术失败的危险因素。结论强调了治疗失败的两个主要危险因素：与创伤机制和一般病变评估有关的因素以及与手术部位情况有关的因素。在外科手术和治疗方面，没有过度失败的风险。简易的爆炸装置创伤机制（OR = 1.56； p = 0.02）和两次清创术后手术部位污染的持续存在（OR = 1.20； p = 0.04）是截肢手术失败的危险因素。结论强调了治疗失败的两个主要危险因素：与创伤机制和一般病变评估有关的因素以及与手术部位情况有关的因素。在外科手术和治疗方面，没有过度失败的风险。与创伤机制和一般病灶评估有关的，以及与手术部位情况有关的。在外科手术和治疗方面，没有过度失败的风险。与创伤机制和一般病变评估有关的，以及与手术部位状况有关的。在外科手术和治疗方面，没有过度失败的风险。