War-related extremity injuries in children: 89 cases managed in a combat support hospital in Afghanistan

Background Meeting paediatric needs is among the priorities of western healthcare providers working in Afghanistan. Hypothesis Insufficient information is available on paediatric wartime injuries to the extremities. Our objective here was to describe these injuries and their management on the field. Materials and methods We retrospectively reviewed consecutive cases of injuries to the extremities in children

Traitement du pied bot varus équin idiopathique Mise en place de la méthode Ponseti dans un pays émergent

Idiopathic clubfoot is one of the most frequent congenital deformities throughout the world. The Ponseti method is the gold standard for its treatment. This simple, low-cost method is very effective and very appropriate for countries with resource-limited or otherwise precarious health services. It is based on correction of the deformity by successive castings associated with a percutaneous Achilles tenotomy and then foot abduction bracing to maintain the correction. The Ponseti method is now well implemented in most emerging countries, largely due to internet development, but some barriers still limit its diffusion. This study aims to determine the principal barriers, to suggest some improvements, and to stress the essential points of its effective utilization by nonphysicians.Le pied bot varus équin idiopathique est une des pathologies congénitales les plus fréquentes dont la prise en charge précoce repose sur un gold standard : la méthode Ponseti. Il s'agit d'une méthode simple, peu coûteuse, donnant de très bons résultats dans le cadre de pieds bots varus équins idiopathiques, et parfaitement adaptée aux contextes de soins précaires. Elle repose en effet sur une correction de la déformation par l'application de plâtres successifs associée à une ténotomie percutanée du tendon d'Achille, et suivie d'une période d'entretien de la correction par le port d'attelles d'abduction pouvant être réalisées de façon artisanale. Si la mise en place de la méthode Ponseti est bien amorcée dans la plupart des pays émergents, notamment grâce au développement de réseaux Internet, son développement reste limité par endroits pour diverses raisons. Ce travail se propose de mettre en évidence les principaux freins à la diffusion de cette méthode dans les pays émergents, et de proposer des axes d'amélioration tout en rappelant les éléments indispensables à son utilisation par des praticiens non spécialisés

The French Advanced Course for Deployment Surgery (ACDS) called Cours Avancé de Chirurgie en Mission Extérieure (CACHIRMEX): history of its development and future prospects

Introduction The composition of a French Forward Surgical Team (FST) has remained constant since its creation in the early 1950s: 12 personnel, including a general and an orthopaedic surgeon. The training of military surgeons, however, has had to evolve to adapt to the growing complexities of modern warfare injuries in the context of increasing subspecialisation within surgery. The Advanced Course for Deployment Surgery (ACDS)?called Cours Avancé de Chirurgie en Mission Extérieure (CACHIRMEX)?has been designed to extend, reinforce and adapt the surgical skill set of the FST that will be deployed. Methods Created in 2007 by the French Military Health Service Academy (Ecole du Val-de-Grâce), this annual course is composed of five modules. The surgical knowledge and skills necessary to manage complex military trauma and give medical support to populations during deployment are provided through a combination of didactic lectures, deployment experience reports and hands-on workshops. Results The course is now a compulsory component of initial surgical training for junior military surgeons and part of the Continuous Medical Education programme for senior military surgeons. From 2012, the standardised content of the ACDS paved the way for the development of two more team-training courses: the FST and the Special Operation Surgical Team training. The content of this French military original war surgery course is described, emphasising its practical implications and future prospects. Conclusion The military surgical training needs to be regularly assessed to deliver the best quality of care in an context of evolving modern warfare casualties