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International Orthopaedics

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01-09-2020 | Polytrauma | Original Paper

Management of orthopaedic injuries in Libyan civil war: experiences of a distant hospital

Authors: Çağdaş Biçen, Mehmet Akdemir, Ahmet Ekin

Published in: International Orthopaedics | Issue 9/2020

Abstract

Aim of the study

In this study, we aimed to evaluate the musculoskeletal injury types, infections, and treatments of the patients injured in Libyan civil war.

Methods

A total of 291 patients (288 male, 3 female) treated in our clinic, between November 2011 and April 2020, were included in our retrospective study. Patients’ age, injury severity score (ISS), injury type, mechanism, location, accompanying traumas, infection, and operations in Libya and in our clinic were evaluated.

Results

Injuries were caused by gunshots in 172 patients, by explosives in 56, by missiles in eight, and by different mechanisms in the remaining 55 patients. Injuries were located mostly in lower extremities, followed by upper extremities and by both extremities. The most common fracture was tibial fractures, followed with femur and humerus. Plate-screw fixation was performed for 82 cases, intramedullary nailing for 42, external fixator for 41, K-wire fixation for 27, foreign body excisions for 26, arthrodesis for 15, amputation for , arthroplasty for 11, and soft tissue operations for 78. Infection was present among 50 (% 17.2) patients. Complications were seen in five patients. Three patients needed implant removal due to infection, one patient had a plate fracture, and one patient died because of sepsis.

Discussion

Difficulties in the treatment of war injuries begin in the battlefield. Patients’ transfers and treatments may not be provided properly due to unsuitable conditions. Hospitals in neighbouring and distant countries can be helpful for supporting the treatment of increased numbers of injured patients.

Conclusion

Wars cause excessive numbers of injuries. In this study, we want to show that hospitals far from war zones can be considered as alternatives for treatment of these injuries.

Hakimoglu S, Karcıoglu M, Tuzcu K et al (2015) Assessment of the perioperative period in civilians injured in the Syrian civil war. Braz J Anesthesiol 65:445–449. https://doi.org/10.1016/j.bjane.2014.03.003CrossRefPubMed

Aboutanos MB, Baker SP (1997) Wartime civilian injuries: epidemiology and intervention strategies. J Trauma 43:719–726. https://doi.org/10.1097/00005373-199710000-00031CrossRefPubMed

Smith JE (2011) The epidemiology of blast lung injury during recent military conflicts: a retrospective database review of cases presenting to deployed military hospitals, 2003-2009. Philos Trans R Soc Lond Ser B Biol Sci 366:291–294. https://doi.org/10.1098/rstb.2010.0251CrossRef

Atiyeh BS, Gunn SW, Hayek SN (2007) Military and civilian burn injuries during armed conflicts. Ann Burns Fire Disasters 20:203–215PubMedPubMedCentral

Alhammoud A, Maaz B, Alhaneedi GA, Alnouri M (2019) External fixation for primary and definitive management of open long bone fractures: the Syrian war experience. Int Orthop 43:2661–2670. https://doi.org/10.1007/s00264-019-04314-0CrossRefPubMed

Murray CK, Obremskey WT, Hsu JR et al (2011) Prevention of infections associated with combat-related extremity injuries. J Trauma 71:235–257. https://doi.org/10.1097/TA.0b013e318227ac5fCrossRef

Covey DC (2006) Combat orthopaedics: a view from the trenches. J Am Acad Orthop Surg 14:10–17. https://doi.org/10.5435/00124635-200600001-00004CrossRef

Hansen MO, Polly DW, McHale KA, Asplund LM (1994) A prospective evaluation of orthopedic patients evacuated from operations desert shield and desert storm: the Walter reed experience. Mil Med 159:376–380CrossRef

Owens BD, Kragh JF Jr, Macaitis J, Svoboda SJ, Wenke JC (2007) Characterization of extremity wounds in operation Iraqi freedom and operation enduring freedom. J Orthop Trauma 21(4):254–257. https://doi.org/10.1097/BOT.0b013e31802f78fbCrossRefPubMed

10.

Balazs GC, Dickens JF, Brelin AM, Wolfe JA, Rue JP, Potter BK (2015) Analysis of orthopaedic research produced during the wars in Iraq and Afghanistan. Clin Orthop Relat Res 473:2777–2784. https://doi.org/10.1007/s11999-015-4244-7CrossRefPubMedPubMedCentral

11.

Mushtaque M, Mir MF, Bhat M et al (2012) Pellet gunfire injuries among agitated mobs in Kashmir. Ulus Travma Acil Cerrahi Derg 18:255–259. https://doi.org/10.5505/tjtes.2012.47639CrossRefPubMed

12.

Kalinterakis G, Koutras A, Syllaios A et al (2019) The evolution and impact of the “damage control orthopedics” paradigm in combat surgery: a review. Eur J Orthop Surg Traumatol 29:501–508. https://doi.org/10.1007/s00590-018-2320-xCrossRefPubMed

13.

Giannoudis PV (2003) Surgical priorities in damage control in polytrauma. J Bone Joint Surg (Br) 85:478–483. https://doi.org/10.1302/0301-620x.85b4.14217CrossRef

14.

Mathieu L, Ouattara N, Poichotte A et al (2014) Temporary and definitive external fixation of war injuries: use of a French dedicated fixator. Int Orthop 38:1569–1576. https://doi.org/10.1007/s00264-014-2305-2CrossRefPubMedPubMedCentral

15.

Ng C, Mifsud M, Borg JN, Mizzi C (2015) The Libyan civil conflict: selected case series of orthopaedic trauma managed in Malta in 2014. Scand J Trauma Resusc Emerg Med 23:103. https://doi.org/10.1186/s13049-015-0183-2CrossRefPubMedPubMedCentral

16.

Anakwe RE, Standley DM (2006) Hand injuries at a British military hospital on operations. J Hand Surg (Br) 31:240–243. https://doi.org/10.1016/j.jhsb.2005.06.025CrossRef

17.

Brown KV, Guthrie HC, Ramasamy A, Kendrew JM, Clasper J (2012) Modern military surgery: lessons from Iraq and Afghanistan. J Bone Joint Surg (Br) 94:536–543. https://doi.org/10.1302/0301-620X.94B4.28602CrossRef

18.

Evriviades D, Jeffery S, Cubison T, Lawton G, Gill M, Mortiboy D (2011) Shaping the military wound: issues surrounding the reconstruction of injured servicemen at the Royal Centre for Defence Medicine. Philos Trans R Soc Lond Ser B Biol Sci 366:219–230. https://doi.org/10.1098/rstb.2010.0237CrossRef

19.

Mathieu L, Bazile F, Barthélémy R, Duhamel P, Rigal S (2011) Damage control orthopaedics in the context of battlefield injuries: the use of temporary external fixation on combat trauma soldiers. Orthop Traumatol Surg Res 97:852–859. https://doi.org/10.1016/j.otsr.2011.05.014CrossRefPubMed

20.

Lloyd BA, Murray CK, Shaikh F et al (2017) Early infectious outcomes after addition of fluoroquinolone or aminoglycoside to posttrauma antibiotic prophylaxis in combat-related open fracture injuries. J Trauma Acute Care Surg 83:854–861. https://doi.org/10.1097/TA.0000000000001609CrossRefPubMedPubMedCentral

21.

Bektaş YE, Özmanevra R, Polat B, Kabay M, Demirkıran ND (2020) Orthopedic treatment, complications, and cost analysis of 67 soldiers injured in a three-month period. Jt Dis Relat Surg 31:102–108. https://doi.org/10.5606/ehc.2020.71808CrossRefPubMed

22.

Akkucuk S, Aydogan A, Yetim I et al (2016) Surgical outcomes of a civil war in a neighbouring country. J R Army Med Corps 162:256–260. https://doi.org/10.1136/jramc-2015-000411CrossRefPubMed

23.

Bodalal Z, Mansor S (2013) Gunshot injuries in Benghazi-Libya in 2011: the Libyan conflict and beyond. Surgeon 11:258–263. https://doi.org/10.1016/j.surge.2013.05.004CrossRefPubMed

24.

Duramaz A, Bilgili MG, Bayram B, Ziroğlu N, Bayrak A, Avkan MC (2017) Orthopedic trauma surgery and hospital cost analysis in refugees; the effect of the Syrian civil war. Int Orthop 41:877–884. https://doi.org/10.1007/s00264-016-3378-xCrossRefPubMed

25.

Penn-Barwell JG, Roberts SA, Midwinter MJ, Bishop JR (2015) Improved survival in UK combat casualties from Iraq and Afghanistan: 2003-2012. J Trauma Acute Care Surg 78:1014–1020. https://doi.org/10.1097/TA.0000000000000580CrossRefPubMed

Title: Management of orthopaedic injuries in Libyan civil war: experiences of a distant hospital
Authors: Çağdaş Biçen
Mehmet Akdemir
Ahmet Ekin
Publication date: 01-09-2020
Publisher: Springer Berlin Heidelberg
Keywords: Polytrauma
Polytrauma
External Fixator
Published in: International Orthopaedics / Issue 9/2020
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-020-04755-y

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Springer Medicine

Management of orthopaedic injuries in Libyan civil war: experiences of a distant hospital

Abstract

Aim of the study

Methods

Results

Discussion

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Aim of the study

Methods

Results

Discussion

Conclusion

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