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+Five-year-old male patient who, after suffering an Improvised Explosive Device (IED) attack in a public place, was evacuated to a local health care centre and was first diagnosed with a diaphyseal fracture of the left femur. The fracture was not adequately reduced and he was immobilised in a splint. He was evacuated to the second Spanish military surgical echelon ROLE 2 in Herat, Afghanistan for definitive treatment.
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+After noting the unacceptable fracture reduction, it was decided to carry out a surgical procedure of Damage Control Orthopaedics consisting of a reduction and immobilisation by external fixation.
+In the absence of TENS-type elastic endomedullary rods or external fixators for the paediatric age group, external fixation by means of an external wrist fixator (used as a circumstantial method) on the left femoral diaphysis was decided upon.
+In the operating theatre and after anaesthetic optimisation, the surgical procedure is performed, which involves debridement of the necrotic soft tissues with profuse pulsatile lavage. Scopy confirmed the presence of a transverse and unstable femoral diaphysis fracture. Closed reduction with scopic control of the fracture was performed, and an external fixation technique was carried out by implanting a Stryker™ TRIAX external fixator (wrist and small fragment external fixator used here as a method of circumstance) in a monoplane and monotube configuration. Two proximal pins and two distal pins and check under scopia for correct pin placement.
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