Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2015

Open Access 01-12-2015 | Case report

The Libyan civil conflict: selected case series of orthopaedic trauma managed in Malta in 2014

Authors: Colin Ng, Max Mifsud, Joseph N. Borg, Colin Mizzi

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2015

Login to get access

Abstract

Aim

The purpose of this series of cases was to analyse our management of orthopaedic trauma casualties in the Libyan civil war crisis in the European summer of 2014. We looked at both damage control orthopaedics and for case variety of war trauma at a civilian hospital. Due to our geographical proximity to Libya, Malta was the closest European tertiary referral centre. Having only one Level 1 trauma care hospital in our country, our Trauma and Orthopaedics department played a pivotal role in the management of Libyan battlefield injuries. Our aims were to assess acute outcomes and short term mortality of surgery within the perspective of a damage control orthopaedic strategy whereby aggressive wound management, early fixation using relative stability principles, antibiotic cover with adequate soft tissue cover are paramount. We also aim to describe the variety of war injuries we came across, with a goal for future improvement in regards to service providing.

Methods

Prospective collection of six interesting cases with severe limb and spinal injuries sustained in Libya during the Libyan civil war between June and November 2014.

Conclusions

We applied current trends in the treatment of war injuries, specifically in damage control orthopaedic strategy and converting to definitive treatment where permissible. The majority of our cases were classified as most severe (Type IIIB/C) according to the Gustilo-Anderson classification of open fractures. The injuries treated reflected the type of standard and improved weaponry available in modern warfare affecting both militants and civilians alike with increasing severity and extent of damage. Due to this fact, multidisciplinary team approach to patient centred care was utilised with an ultimate aim of swift recovery and early mobilisation. It also highlighted the difficulties and complex issues required on a hospital management level as a neighbouring country to war zone countries in transforming care of civil trauma to military trauma.
Literature
1.
Akkucuk S, Aydogan A, Yetim I, Ugur M, Oruc C, Kilic E, et al. Surgical outcome of a civil war in neighbouring country. J R Army Med Corps. 2015;0:1–5. doi:10.​1136/​jramc-2015-000411.
2.
Covey DC. Combat orthopaedics: a view from the trenches. J Am Acad Orthop Surg. 2000;14:S10–7.
3.
Murray CK, Obremskey WT, Hsu JR, Andersen RC, Calhoun JH, Clasper JC, et al. Prevention of infections associated with combat-related extremity injuries. J Trauma. 2011; Aug:71(2 Suppl 2):S235-257. doi:10.​1097/​TA.​0b013e318227ac5f​.
4.
Ramasamy A, Harrisson SE, Stewart MPM, Midwinter M. Penetrating missile injuries during the Iraqi insurgency. Ann R Coll Surg Eng. 2009;91:551–8.CrossRef
5.
Mathieu L, Bazile F, Barthelemy R, Duhamel P, Rigal S. Damage control orthopaedics in the context of battlefield injuries: The use of temporary external fixation on combat trauma soldiers. Orthop Traumatol Surg Res. 2011;97:852–9.CrossRefPubMed
6.
Mazurek MT, Ficke JR. The scope of wounds encountered in casualties from the global war on terrorism: from the battlefield to the tertiary treatment facility. J Am Acad Orthop Surg. 2006;14:S16–23.
7.
Gustilo RB, Anderson JT. Prevention of infection in treatment of one thousand and twenty five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976;58:453–8.PubMed
8.
Melvin JS, Dombroski DG, Torbert JT, Kovach SJ, Esterhai JL, Mehta S. Open tibial shaft fractures: I. Evaluation and initial wound management. J Am Aca Orthop Surg. 2010;18:10.
9.
Ruedi TP, Murphy WM. AO Principles of Fracture Management. Stuttgart. New York, Davos Platz, Switzerland: Thieme. 2000.
10.
Hannigan GD, Pulos N, Grice EA, Mehta S. Current concepts and on-going research in the prevention and treatment of open fracture infections. Advances in wound care. 2015; Vol 4:Number 1. doi:10.​1089/​wound.​2014.​0531.
11.
Roberts CS, Pape HC, Jones AL, Malkani AL, Rodriguez JL, Giannoudis PV. Damage Control Orthopaedics- Evolving concepts in the treatment of patients who have sustained orthopaedic trauma. J Bone Joint Surg Am. 2005;87(2):434–49.
12.
13.
Rotondo MF, Schwab CW, McGonigal MD, Phillips 3rd GR, Fruchterman TM, Kauder DR, et al. ‘Damage control’: an approach for improved survival in exsanguinating penetrating abdominal injury. J Traum. 1993;35:375–83.CrossRef
14.
Pape HC, Hildebrand F, Pertschy S, Zelle B, Garapati R, Grimme K, et al. Changes in the management of femoral shaft fractures in polytrauma patients: from early total care to damage control orthopaedic surgery. J Trauma. 2002;53(3):452–61.CrossRefPubMed
15.
Pape HC, Giannoudis P, Kretteck C. The timing of fracture treatment in polytrauma patients: relevance of damage control orthopaedic surgery. Am J Surg. 2002;183:622–9.CrossRefPubMed
16.
Hildebrand F, Giannoudis P, Kretteck C, Pape HC. Damage control: extremities. Injury. 2004;35:678–89.CrossRefPubMed
17.
Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: A new classification of type III open fractures. J Trauma. 1984;24(8):742–6.CrossRefPubMed
18.
Mody RM, Zapor M, Hartzell JD, Robben PM, Waterman P, Wood-Morris R, et al. Infectious complications of damage control orthopedics in war trauma. J Trauma. 2009;Oct;67(4):758–61. doi:10.​1097/​TA.​0b013e3181af6aa6​.
19.
Della Rocca GJ, Crist BD. External fixation versus conversion to intramedullary nailing for definitive management of closed fractures of the femoral and tibial shaft. J Am Acad Orthop Surg. 2006;14(10 Spec No):S131–5.PubMed
Metadata
Title
The Libyan civil conflict: selected case series of orthopaedic trauma managed in Malta in 2014
Authors
Colin Ng
Max Mifsud
Joseph N. Borg
Colin Mizzi
Publication date
01-12-2015
Publisher
BioMed Central
DOI
https://doi.org/10.1186/s13049-015-0183-2

Other articles of this Issue 1/2015

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2015 Go to the issue

Original research

The novel intubating laryngeal tube (iLTS-D) is comparable to the intubating laryngeal mask (Fastrach) – a prospective randomised manikin study

Original research

The risk of pediatric bicycle handlebar injury compared with non-handlebar injury: a retrospective multicenter study in Osaka, Japan

Original research

A mobile minimally invasive interventional shelter: a new answer to on-spot emergency treatment of large arterial injuries?

Editorial

Emergency surgery over 111 years: are we still at a crossroads or ready for emergency surgery 2.0?

Original research

Load-distributing-band cardiopulmonary resuscitation for out-of-hospital cardiac arrest increases regional cerebral oxygenation: a single-center prospective pilot study

Original research

Hemodialysis with end-stage renal disease did not raise the risk of intracranial hemorrhage after a head injury