• Médecins Sans Frontières Experience in Orthopedic Surgery in Postearthquake Haiti in 2010

      Teicher, C L; Alberti, K; Porten, K; Elder, G; Baron, E; Herard, P (Cambridge University Press, 2014-01-15)
      Introduction During January 2010, a 7.0 magnitude earthquake struck Haiti, resulting in death and destruction for hundreds of thousands of people. This study describes the types of orthopedic procedures performed, the options for patient follow-up, and limitations in obtaining outcomes data in an emergency setting. Problem There is not a large body of data that describes larger orthopedic cohorts, especially those focusing on internal fixation surgeries in resource-poor settings in postdisaster regions. This article describes 248 injuries and over 300 procedures carried out in the Médecins Sans Frontières-Orthopedic Centre Paris orthopedic program.
    • Reconstruction of Nonunion Tibial Fractures in War-Wounded Iraqi Civilians, 2006-2008: Better Late Than Never

      Fakri, R M; Al Ani, A M K; Rose, A M C; Alras, M S; Daumas, L; Baron, E; Khaddaj, S; Hérard, P; Médecins sans Frontières, Paris, France; Chronic Disease Research Centre, University of the West Indies, Bridgetown, Barbados; Epicentre, Paris, France; Women and Health Alliance (WAHA) International, Paris, France (Lippincott Williams & Wilkins, 2012-01-10)
      OBJECTIVE
    • Reconstruction of Residual Mandibular Defects by Iliac Crest Bone Graft in War-wounded Iraqi civilians, 2006-2011

      Guerrier, G; Alaqeeli, A; Al Jawadi, A; Foote, N; Baron, E; Albustanji, A; Epicentre, 8 rue Saint Sabin, 75011 Paris, France. Electronic address: guerriergilles@gmail.com. (2012-06-28)
      Our aim was to assess the long-term results, complications, and factors associated with failure of mandibular reconstructions among wounded Iraqi civilians with mandibular defects. Success was measured by the quality of bony union, and assessed radiographically and by physical examination. Failures were defined as loss of most or all of the bone graft, or inability to control infection. During the 6-year period (2006-2011), 35 Iraqi patients (30 men and 5 women, mean age 33 years, range 15-57) had residual mandibular defects reconstructed by iliac crest bone grafts. The causes were bullets (n=29), blasts (n=3), and shrapnel (n=3). The size of the defect was more than 5cm in 19 cases. Along the mandible the defect was lateral (n=14), central/lateral (n=5), lateral/central/lateral in continuity (n=6), and central in continuity (n=10). The mean time from injury to operation was 548 days (range 45-3814). All but 2 patients had infected lesions on admission. Bony fixation was ensured by locking reconstruction plates (n=27), non-locking reconstruction plates (n=6), and miniplates (n=2). Complications were associated with the reconstruction plate in 2 cases, and donor-site morbidity in 5. After a mean follow-up of 17 months (range 6-54), bony union was achieved in 28 (80%). The quality of the bone was adequate for dental implants in 23 cases (66%). Our results suggest that war-related mandibular defects can be reconstructed with non-vascularised bone grafts by multistage procedures with good results, provided that the soft tissues are in good condition, infection is controlled, and the method of fixation is appropriate. Further studies are needed to assess the role of vascularised free flaps in similar conditions.
    • The short musculoskeletal functional assessment (SMFA) score amongst surgical patients with reconstructive lower limb injuries in war wounded civilians

      Teicher, C; Foote, N L; Al Ani, A M K; Alras, M S; Alqassab, S I; Baron, E; Ahmed, K; Herard, P; Fakhri, R M (Elsevier, 2014-10-24)
      The MSF programme in Jordan provides specialized reconstructive surgical care to war-wounded civilians in the region. The short musculoskeletal functional assessment score (SMFA) provides a method for quantitatively assessing functional status following orthopaedic trauma. In June 2010 the Amman team established SMFA as the standard for measuring patients' functional status. The objective of this retrospective study is to evaluate whether the SMFA scores can be useful for patients with chronic war injuries.
    • Surgical Care of Pediatric Patients in the Humanitarian Setting: The Médecins Sans Frontières Experience, 2012-2013

      Trudeau, MO; Baron, E; Hérard, P; Labar, AS; Lassalle, X; Teicher, CL; Rothstein, DH (American Medical Association, 2015-11-01)
      Little is known about the scope of practice and outcomes in pediatric surgery performed by humanitarian organizations in resource-poor settings and conflict zones. This study provides the largest report to date detailing such data for a major nongovernmental organization providing humanitarian surgical relief support in these settings.