Host Nation Casualties

One particular challenge for medical providers in an under-resourced host nation is the likelihood of treating individuals with unknown follow-up care. Low-energy, closed fractures may be treated definitively with a splint or cast. Plaster often is preferred to fiberglass for casting, as cast saws may not be locally available. Certain low-energy fractures may warrant open reduction and internal fixation or closed reduction and percutaneous pinning. External fixation is also an option for initial stabilization if transfer to a host nation facility is possible, or tempo of casualties allows for delayed internal stabilization. External fixation can be used successfully to definitively treat fractures but requires careful pin placement, long term construct stability and close follow up that may not be possible. In the setting of high-energy wounds with extensive soft tissue loss, a staged amputation that may be definitively closed in a short period of time must be considered. Unavailability of prolonged and advanced surgical care make limb salvage challenging.