War-related orthopedic injuries: a comprehensive analysis from Benghazi medical center 2013-2016

Authors

  • Ayman Alhoiti Department of Trauma and Orthopedics, Faculty of Medicine, Benghazi University, Libya
  • Hassan Abushaala Department of Trauma and Orthopedics, Faculty of Medicine, Benghazi University, Libya
  • Mustafa Elfadli Department of Trauma and Orthopedics, Faculty of Medicine, Benghazi University, Libya

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20242376

Keywords:

War-related injuries, Orthopedic trauma, Gunshot wounds, Emergency management, Explosive injuries, Injury patterns, Conflict-affected regions

Abstract

Background: The majority of war-related injuries involve the extremities and typically necessitate surgical intervention. These injuries are notably severe due to the impact of high-velocity rockets, including gunshot wounds and blast injuries. However, epidemiology of the war-related injuries of the last decade Libyan conflict remains under investigated. The study aimed to illustrate the characteristics of the cases volume, mechanism of injury, and the emergency department management protocol.

Methods: A retrospective observational study included all patients admitted to the orthopedic department with war-related injuries between December 2013 and December 2016. Relevant data collected included patient demographics, injury patterns, and treatment modalities. The data was organized and analyzed using SPSS statistical software.

Results: The 563 patients with war-related orthopedic injuries were treated during the study period. The highest percentage of patients were seen in 2015 (45%) and 2014 (44.2%), with a peak in July/summer months. Most patients were male (86.3%) with a mean age of 30.5 years. The most common causes of injury were gunshot wounds (36.1%) and explosions (28.2%), primarily affecting the upper (35%) and lower (29.3%) extremities. The 75.7% of injuries resulted in fractures, with 16.2% having associated injuries like bowel, nerve, and amputation. The most common emergency interventions were damage control surgery, debridement, and fixation.

Conclusions: This data provides valuable insights into the complex nature of war-related orthopedic injuries and the challenges healthcare teams face in conflict-affected regions. The findings underscore the critical need to strengthen the resilience and capacity of medical systems to effectively address the specific needs of war trauma.

References

Coupland RM. War wounds of limbs: Surgical management. World Health Organization; 2011.

Thouret G, Alan H, Jason HC, Romney CA. Devastation of bone tissue in war-related injuries. J Trauma Acute Care Surg. 2020;78(3):546-52.

Evriviades D, Steven J, Tania C, Graham L, Martin G, Deborah M. The impact of primary contamination in war wounds. J Trauma Acute Care Surg. 2011;71(1):91-7.

Nasr SS, Al-Hayek GY. Immediate medical intervention in war-related injuries. J Trauma Acute Care Surg. 2015;78(3):546-52.

Yee-Sin L, Vasoo S, Cutter J. Infectious disease outbreaks: Tools and approaches for understanding. Ann Academy Med Sing. 2018;47(9):383-5.

Laus M, Ferrara C, Moscatiello R. A global review of war-related injuries. J Milit Med. 2017;182(3):130-5.

Rezaei-Hachesu P, Taghibeigi M. Patterns of injuries in combat-related trauma. J Trauma Manag Outcomes. 2016;10:15.

Kluger Y, Kluger M. Urban warfare: Characteristics and medical response. J Emergency Med. 2015;49(6):899-902.

Qadir NA, Bashir A, Tahir M. Patterns of injuries in urban warfare: Experience from conflict zones. Trauma Monthly. 2019;24(2):72-7.

Rosenfeld JV, Watkins RA, Peleg K. Medical management of blast injuries. J Milit Med. 2018;182(4):369-76.

Sharma S, Lalwani S, Unnikrishnan B. Extremity injuries in combat: A systematic review. Int J Crit Illness Injury Sci. 2020;10(1):25-30.

Penn-Barwell JG, Sargeant ID, Hughes A. War-related fractures: Treatment and outcomes. J Orthopaed Trauma. 2016;30(5):227-31.

Velmahos GC, Degiannis E, Doll D. Gunshot wounds: Surgical management. Ann Surg. 2003;238(5):713-21.

Naqvi GA, Shah A. Complications of war injuries: A review of bowel trauma. J Royal Army Med Corps. 2017;163(4):289-94.

Nasr SS, Al-Hayek GY. Nerve injuries in combat: Diagnosis and management. J Trauma Acute Care Surg. 2015;78(3):546-52.

Semer NB, Hastings CE, Mody GN. Resource-limited settings: Surgery and the global healthcare landscape. World J Surg. 2014;38(7):1642-8.

Wani RA, Baba AA. Orthopedic trauma in resource-limited settings: Challenges and solutions. J Clin Orthop Trauma. 2020;11(3):409-15.

Abo-Elfetoh N, Alghamdi A, Alqurashi A. Emergency preparedness in conflict zones: A review of strategies. J Emergency Med. 2015;48(1):123-30.

Chu KM, Ford N, Trelles M. Health systems in conflict-affected settings: Strategies and outcomes. The Lancet. 2019;394(10194):626-35.

Gaarder M, Garcia M. Long-term impacts of war injuries: Economic and social consequences. J Peace Res. 2013;50(5):609-21.

Williamson RA, Burns SC. Rehabilitation in conflict zones: Strategies and outcomes. Int J Physical Med Rehabilitat. 2017;5(4):367-74.

Elrahim MA, Eskander M, Sulafa A, Iman A, Suzan A, Noor B, et al. War-related injuries in the Syrian conflict: A review of cases. J Trauma Acute Care Surg. 2016;81(4):736-40.

Mohammed KA, Al-Jabri MH. Impact of conflict on healthcare facilities in Yemen. J Emergency Med. 2017;52(3):328-35.

O'Reilly D. Injuries and medical response in the Afghanistan conflict. British Med J. 2014;348:g3326.

Owens BD, John FK, Joseph CW, Joseph M, Charles EW, John BH. Combat wounds in operation Iraqi freedom and operation enduring freedom. J Trauma. 2008;64(2):295-9.

Ramasamy A. Blast-related fractures: Injury patterns and treatment. J Bone Joint Surg. 2011;93(9):950-53.

Place RJ. Gunshot wounds: Management and outcomes in a combat setting. J Trauma. 2009;66(4):S121-6.

Beekley AC. Early management of war-related injuries at a US Army medical center. J Am College Surg. 2008;206(2):236-41.

Glassberg E. Modern military surgery: lessons from Israel’s national experience. Lancet. 2014;384(9948):450-9.

Kotwal RS, Butler FK, Edgar EP, Shackelford SA, Bennett DR, Bailey JA. Saving lives on the battlefield: A joint trauma system review of prehospital trauma care in combined joint operations area Afghanistan. J Spec Oper Med. 2013;13(1):77-85.

Kotwal RS, Montgomery HR, Kotwal BM, Champion HR, Butler FK, Mabry RL, et al. Eliminating preventable death on the battlefield. Arch Surg. 2011;146(12):1350-8.

Mabry RL, De Lorenzo RA. Improving role I battlefield casualty care from point of injury to surgery. US Army Med Department J. 2011;1:87-91.

Caravalho JR. Prehospital combat casualty care: The US experience. Trauma Surg Acute Care Open. 2018;3(1):e000211.

Eastridge BJ, Mabry RL, Seguin P, Cantrell J, Tops T, Uribe P, et al. Death on the battlefield (2001-2011): Implications for the future of combat casualty care. J Trauma Acute Care Surg. 2012;73(6):S431-7.

Gawande A. Casualties of war-Military care for the wounded from Iraq and Afghanistan. N Eng J Med. 2004;351(24):2471-5.

Holcomb JB, McMullin NR, Pearse L, Caruso J, Wade CE, Oetjen-Gerdes L, et al. Causes of death in U.S. Special Operations Forces in the global war on terrorism: 2001-2004. Ann Surg. 2006;243(6):841-7.

Rodriguez S. The economic impact of traumatic injuries: Long-term care and rehabilitation. J Rehab Res Develop, 2012;49(3):367-78.

Ficke JR. Extremity war injuries: Clinical outcomes and cost of care. J Am Academy Orthop Surgeons. 2012;20:S1-6.

Downloads

Published

2024-08-28

Issue

Section

Original Research Articles