Use of external fixators for damage-control orthopaedics in natural disasters like the 2005 Pakistan earthquake

Awais, Syed Muhammad; Saeed, Ayesha; Ch, Asad

doi:10.1007/s00264-014-2436-5

Cited by 65 publications

(31 citation statements)

References 20 publications

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“…They noted that the use of external fixation and, when necessary, amputation, as a means of DCO allowed fractures to be definitively addressed later by more sufficiently staffed and supplied treatment teams or allowed patients to be transported to better-equipped facilities [ 22 ]. Awais et al noted similar findings, advocating for the use of both external fixation and, when necessary, amputation, after the 2005 earthquake in Pakistan, which claimed more than 73,000 lives [ 20 , 23 ]. A retrospective study after that earthquake reported that in 295 of 1145 fractures (26%), reductions were achieved with external fixation [ 20 ].…”

Section: Discussionmentioning

confidence: 83%

“…The focus should be on hemorrhage management, wound debridement, infection control, and soft tissue stabilization. External fixation is key to proper management of fractures and soft tissue stabilization, yielding favorable results in earthquake disaster scenarios [ 20 – 22 ]. The ratio of external fixation to ORIF depends largely on when the response team arrives at the earthquake location [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

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A review of the epidemiology and treatment of orthopaedic injuries after earthquakes in developing countries

et al. 2017

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BackgroundEarthquakes in developing countries are devastating events. Orthopaedic surgeons play a key role in treating earthquake-related injuries to the extremities. We describe orthopaedic injury epidemiology to help guide response planning for earthquake-related disasters.MethodsSeveral databases were searched for articles reporting primary injury after major earthquakes from 1970 to June 2016. We used the following key words: “earthquake” AND “fracture” AND “injury” AND “orthopedic” AND “treatment” AND “epidemiology.” The initial search returned 528 articles with 253 excluded duplicates. The remaining 275 articles were screened using inclusion criteria, of which the main one was the description of precise anatomic location of fracture. This yielded 17 articles from which we analyzed the ratio of orthopaedic to nonorthopaedic injuries; orthopaedic injury location, type, and frequency; fracture injury characteristics (open vs. closed, single vs. multiple, and simple vs. comminuted); and first-line treatments.ResultsMost injuries requiring treatment after earthquakes (87%) were orthopaedic in nature. Nearly two-thirds of these injuries (65%) were fractures. The most common fracture locations were the tibia/fibula (27%), femur (17%), and foot/ankle (16%). Forty-two percent were multiple fractures, 22% were open, and 16% were comminuted. The most common treatment for orthopaedic injuries in the setting of earthquakes was debridement (33%).ConclusionsOrthopaedic surgeons play a critical role after earthquake disasters in the developing world. A strong understanding of orthopaedic injury epidemiology and treatment is critical to providing effective preparation and assistance in future earthquake disasters.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

A review of the epidemiology and treatment of orthopaedic injuries after earthquakes in developing countries

et al. 2017

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“…Most of the fractures are open (61.4%). According to the principle of damage control orthopaedic surgery, skeletal stabiliation was initially achieved by external fixation (18%) 17. Later internal fixation will be performed in Role 3 Hospital 18.…”

Section: Discussionmentioning

confidence: 99%

Four years of orthopaedic activities in Chinese Role 2 Hospital of eastern Mali peacekeeping area

Zhang

Cao

et al. 2018

BMJ Mil Health

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IntroductionThe Chinese Role 2 Hospital (CHN-Role 2H) Medical Treatment Facility (MTF) was founded in July 2013 as part of the Chinese commitment to Multidimensional Integrated Stabilization Mission in Mali (MINUSMA). It provides medical care for approximately 5200 personnel of the whole Sector East of MINUSMA including UN military personnel, UN police and UN civilian staff. The aim of this study was to determine the orthopaedic surgical activity over a 4-year period to facilitate the training of future Chinese military surgical teams.Materials and methodsSurgical records of all patients operated on at the CHN-Role 2H between 28 March 2014 to 28 March 2018 were identified, and all orthopaedic activity were analysed.ResultsDuring this period, 1190 patients underwent 2024 surgical procedures. Orthopaedic procedures represented 961/2024 (47.5%) of all the procedures. Battle injury (BI) represented 43% of patients. Improvised explosive devices (IEDs) were responsible for 15.8 % casualties. Fractures (49%) and soft tissue injures (43%) were the most common injuries, with 61% of the fractures being open. Damage control surgery including debridement (23.52%) and external fixation (17.90%) were the most frequently performed interventions.ConclusionOrthopaedic surgery is the most frequently performed surgery in the CHN-Role 2H in Mali. The complexity and severity of injuries demonstrate the urgent need for tailored training and extended skill sets for deploying military orthopaedic surgeons.

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“…In many cases, external fixation may be the more appropriate choice of intervention over internal fixation, especially in natural disaster and conflict settings. In this way, even in those settings where the minimum requirements for a procedure like internal fixation do not exist, a high proportion of the trauma caseload may be able to be managed when a procedure like external fixation is possible [15][16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Orthopaedic surgery in natural disaster and conflict settings: how can quality care be ensured?

Alvarado

Trelles

Tayler‐Smith

et al. 2015

International Orthopaedics (SICOT)

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Purpose Médecins sans Frontières (MSF) is one of the main providers of orthopaedic surgery in natural disaster and conflict settings and strictly imposes a minimum set of contextspecific standards before any surgery can be performed. Based on MSF's experience of performing orthopaedic surgery in a number of such settings, we describe: (a) whether it was possible to implement the minimum standards for one of the more rigorous orthopaedic procedures-internal fixation-and when possible, the time frame, (b) the volume and type of interventions performed and (c) the intra-operative mortality rates and postoperative infection rates. Methods We conducted a retrospective review of routine programme data collected between 2007 and 2014 from three MSF emergency surgical interventions in Haiti (following the 2010 earthquake) and three ongoing MSF projects in Kunduz (Afghanistan), Masisi (Democratic Republic of the Congo) and Tabarre (Haiti). ResultsThe minimum standards for internal fixation were achieved in one emergency intervention site in Haiti, and in Kunduz and Tabarre, taking up to 18 months to implement in Kunduz. All sites achieved the minimum standards to perform amputations, reductions and external fixations, with a total of 9,409 orthopaedic procedures performed during the study period. Intraoperative mortality rates ranged from 0.6 to 1.9 % and postoperative infection rates from 2.4 to 3.5 %. Conclusions In settings affected by natural disaster or conflict, a high volume and wide repertoire of orthopaedic surgical procedures can be performed with good outcomes when minimum standards are in place. More demanding procedures like internal fixation may not always be feasible.

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Use of external fixators for damage-control orthopaedics in natural disasters like the 2005 Pakistan earthquake

Cited by 65 publications

References 20 publications

A review of the epidemiology and treatment of orthopaedic injuries after earthquakes in developing countries

A review of the epidemiology and treatment of orthopaedic injuries after earthquakes in developing countries

Four years of orthopaedic activities in Chinese Role 2 Hospital of eastern Mali peacekeeping area

Orthopaedic surgery in natural disaster and conflict settings: how can quality care be ensured?

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