French surgical experience in the Role 3 Medical Treatment Facility of KaIA (Kabul International Airport, Afghanistan): The place of the orthopedic surgery - 05/09/14

Doi : 10.1016/j.otsr.2014.06.010

O. Barbier ^a,^⁎ , B. Malgras ^b, G. Versier ^a,^c, F. Pons ^c, S. Rigal ^d,^c, D. Ollat ^a,^c
^a Service de chirurgie orthopédique et traumatologie, hôpital d’instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
^b Service de chirurgie viscérale, hôpital d’instruction des armées du Val-de-Grâce, 74, boulevard de Port-Royal, 75005 Paris, France
^c École du Val-de-Grâce, 1, place A.-Laveran, 75005 Paris, France
^d Service de chirurgie orthopédique, hôpital d’instruction des armées Percy, 101, avenue H.-Barbusse, 92140 Clamart, France

^⁎Corresponding author.

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En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Friday 05 September 2014
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Abstract

Introduction

In 2009, the French took command of the Medical Hospital (MH) or Role 3 Hospital at KaIA (Kabul International Airport) within the framework of its role in the military mission Operation Pamir in Afghanistan. The goal of this study was to analyze the volume of orthopedic surgical activity for the last four years, to identify its specificities and to improve training of military orthopedic surgeons.

Hypothesis

Orthopedic surgery is the most important activity in the field and surgeons must adapt to situations and injuries that are different from those encountered in France.

Patients and methods

All patients operated on between July 2009 and June 2013 were prospectively included in an electronic database. The analysis included the number of surgical acts and patients, the types of injuries and the surgical procedures.

Results

Forty-three percent (n=1875) of 4318 procedures involved orthopedic surgery. Half of these were emergencies. French military personnel represented 17% of the patients, local civilians 47% and children 17%. Half of the procedures involved the soft tissues, 20% were for bone fixation and 10% for surgery of the hand. The rate of amputation was 6%. The diversity of the surgical acts was high ranging from emergency surgery to surgical reconstruction.

Discussion

The activity of this Role 3 facility is comparable to that of other Role 3 facilities in Afghanistan, with an important percentage of acts involving medical assistance to the local population and scheduled surgeries as well as primary and/or secondary management of the wounded. The diversity of surgical acts confirms the challenge of training military orthopedic surgeons within the context of the hyperspecialization of the civilian sector. Specific training has been organized in France by the École du Val de Grâce. Specific continuing education is also necessary.