ORIGINAL SCIENTIFIC REPORT
Malunion of Long-Bone Fractures in a Conﬂict Zone
in the Democratic Republic of Congo
Edward C. T. H. Tan
Published online: 9 May 2017
Internationale de Chirurgie 2017
Introduction Malunion is a well-recognized complication of long-bone fractures which accounts for more than 25%
of injuries in conﬂict zones. The aim of this study was to investigate the rate of malunion sustained by casualties with
penetrating gunshot wounds in an International Committee of the Red Cross (ICRC) surgical substitution project in
the Democratic Republic of Congo (DRC) and compare these results with current literature.
Methods A retrospective cohort study was performed. All patients admitted to the ICRC facility between the periods
of 01.10.2014 and 31.12.2015 with long-bone fractures caused by gunshot wound were included, and data were
collected retrospectively from the patient’s hospital notes.
Results A total of 191 fractures caused by gunshot were treated in the DRC at the ICRC surgical substitution project
during the study period. On average, the fractures were 3 days old on admission and were all open, with 62% also
being comminuted. The ICRC management protocol, which emphasizes debridement, antibiotic prophylaxis and
conservative fracture stabilization, was followed in all cases. Forty-eight percentage of the fractures were ﬁnally
classiﬁed as ‘union without complication’; however, 17% were classiﬁed as ‘malunion’.
Conclusions This study indicates that open long-bone fractures that are managed by the ICRC surgical substitution
project in DRC may have an increased likelihood of malunion as compared to long-bone fractures treated in
developed countries. Patient delay and mechanism of injury may have caused increased rates of infection which are
likely behind these increased rates of malunion, alongside the lack of deﬁnitive fracture treatment options made
available to the surgical team.
& Grace Bauhahn
Edward C. T. H. Tan
International Committee of the Red Cross, Geneva,
Ministry of Defence, Department of Surgery, Alrijne Medical
Centre Leiderdorp, Leiden University Medical Centre,
Leiden, The Netherlands
Ministry of Defence, Department of Surgery-Trauma
Surgery, Radboud University Medical Center, Nijmegen,
World J Surg (2017) 41:2200–2206