Review of Van earthquakes form an orthopaedic perspective: a multicentre retrospective study

Analysis of amputations occurring in the earthquakes centered in Kahramanmaraş: Adıyaman experience

PURPOSE

Amputations are a common surgical procedure resulting from trauma during earthquakes, leading to severe disability. This study aims to investigate surgical outcomes specific to amputations that occurred in Adıyaman after the Kahramanmaraş earthquakes.

METHODS

This descriptive study included amputees who presented to Adıyaman University Training and Research Hospital. Between March 6, 2024 and March 29, 2024, amputees were contacted by phone and asked the questions in the form. Data analyzed included demographic information, number and level of amputated extremities, phantom limb pain, stump infection, extrication time, time to initiation of rehabilitation, number of revision, and whether a prosthesis was fitted.

RESULTS

The study reached 75 amputees. The mean age was 37.9 ± 19.2, and the most frequently amputated age group was adults. Stump infection was observed in 40 amputees (53.3%), phantom limb pain in 47 (62.6%), and revision in 29 (38.7%). The median extrication time was 36 h and initiation of rehabilitation time was 45 days. It was noted that 35 amputees (62.5%) used prostheses. A statistically significant relationship was found between fasciotomy and stump infection (p = .000). Infection was detected in 65% of those who underwent fasciotomy.

CONCLUSION

Earthquake-related amputations most frequently affected the adult age group and primarily involved lower extremity amputations, such as transfemoral and transtibial amputations. Phantom limb pain, need for revision, and infection are common in earthquake-induced amputations. Delayed fasciotomy increases the risk of stump infection. The data obtained in this study will help plan local health services to coordinate amputation care in disasters.

Review of the treatment options and results of earthquake-related pelvic injuries after the Türkiye earthquake on 6th February

The aim of this study was to review the characteristics and classifications of pelvic injuries due to earthquake trauma, to determine the treatment options and outcomes, and to present the experiences of our single trauma center. Sixty patients (23 male, 37 female) who underwent surgical treatment for pelvic ring injuries after the earthquake were analyzed in this study. Demographic data, such as age and gender, operations, and fracture details were recorded. Laboratory results and the amount of blood used were included in the analysis. Fractures were classified according to the Young-Burgess classification. Surgical treatment methods, side of injury, accompanying injuries, and treatment results were analyzed using SPSS software. Left-sided trauma was the most common mechanism of injury, with 36 patients (60%) sustaining left-sided pelvic fractures. Pelvic ring fractures were detected in 78.3% of patients, and combined acetabulum and pelvic ring fractures were identified in 21.7% of patients. Thoracic trauma and extra-pelvic fractures were seen in 12 (20%) and 18 (30%) patients, respectively. Twenty percent of patients underwent emergency abdominal surgery prior to pelvic surgery. Complications were observed in 7 patients (11.6%) in the early period. The average amount of blood used for patients was 2.91 U (min: 0, max: 13 U, SD: 2.66). This study has shown us that lateral compression injuries are more common, and that low hemoglobin levels, high inflammation parameters, previous abdominal surgery, accompanying fractures, and lung injury are the main characteristics of patients with earthquake-related pelvic injuries. It also demonstrates that for the optimal use of materials and implants, experience in different techniques is required, and shows the significant need for blood transfusions in the treatment of these injuries. Level IV, Therapeutic study.

Comparison of single and double incision leg fasciotomy in disaster settings-Experience from 2023 Türkiye earthquakes

INTRODUCTION

Although there are studies comparing methods for leg fasciotomy in compartment syndrome after fractures, choice of single or double fasciotomies in disasters was not investigated. The aim of this study was to compare the efficacy of single and double incision leg fasciotomy in the setting of disaster.

METHODS

Patients that have undergone fasciotomy after 2023 Kahramanmaraş earthquakes were retrospectively analyzed. The cases were separated into two groups as single incision and double incision according to the method of the first fasciotomy. The number of debridements after each fasciotomy, muscle group excisions, completion time of treatment, presence of amputation, the method of closure (primary closure or graft/flap) and positive results of wound cultures were analyzed and compared between two groups.

RESULTS

62 legs of 52 patients (22 females, 30 males, age 36.9 ± 11.2 years) with compartment syndrome that have undergone fasciotomy after 2023 Kahramanmaraş earthquakes were included in the study. Single-incision group included 27 legs and double incision group included 35 legs. Amputation was needed in 15 patients (%24.2), six in single incision group and nine in double incision group. (p = 0.75). Compartment excision (eight patients in single incision, nine patients in double incision groups, p = 0.81), number of debridements (median 4 in both groups, p = 0.55), wound closure time (median 17 days in single incision, 22 days in double incision groups, p = 0.52), graft or flap requirement (11 patients in single incision, 16 patients in double incision groups, p = 0.53), positive culture results (15 patients in single incision, 16 patients in double incision groups, p = 0.44) were not different statistically between two groups.

CONCLUSION

Single and double incision fasciotomy methods are equally effective and safe in treatment of compartment syndrome of the leg in disaster situations. To our knowledge, this is the first study comparing outcomes of single and double incision fasciotomy in disaster settings.

Surgical and critical care management of earthquake musculoskeletal injuries and crush syndrome: A collective review

Earthquakes are unpredictable natural disasters causing massive injuries. We aim to review the surgical management of earthquake musculoskeletal injuries and the critical care of crush syndrome. We searched the English literature in PubMed without time restriction to select relevant papers. Retrieved articles were critically appraised and summarized. Open wounds should be cleaned, debrided, receive antibiotics, receive tetanus toxoid unless vaccinated in the last 5 years, and re-debrided as needed. The lower limb affected 48.5% (21.9%-81.4%) of body regions/patients. Fractures occurred in 31.1% (11.3%-78%) of body regions/patients. The most common surgery was open reduction and internal fixation done in 21% (0%-76.6%), followed by plaster of Paris in 18.2% (2.3%-48.8%), and external fixation in 6.6% (1%-13%) of operations/patients. Open fractures should be treated with external fixation. Internal fixation should not be done until the wound becomes clean and the fractured bones are properly covered with skin, skin graft, or flap. Fasciotomies were done in 15% (2.8%-27.2%), while amputations were done in 3.7% (0.4%-11.5%) of body regions/patients. Principles of treating crush syndrome include: (1) administering proper intravenous fluids to maintain adequate urine output, (2) monitoring and managing hyperkalemia, and (3) considering renal replacement therapy in case of volume overload, severe hyperkalemia, severe acidemia, or severe uremia. Low-quality studies addressed indications for fasciotomy, amputation, and hyperbaric oxygen therapy. Prospective data collection on future medical management of earthquake injuries should be part of future disaster preparedness. We hope that this review will carry the essential knowledge needed for properly managing earthquake musculoskeletal injuries and crush syndrome in hospitalized patients.

Evaluation of the demographic characteristics and general health status of earthquake survivors affected by the 2023 Kahramanmaraş earthquake; a section from Gaziantep Nurdağı district

BACKGROUND

An earthquake with a magnitude of 7.7 occurred in Pazarcık District of Turkey at 04.17 on February 6, 2023 and another earthquake of 7.6 occurred at 13.24 on the same day. This is the second largest earthquake to have occurred in Turkey. The aim of this study is to investigate the earthquake-related level of knowledge, attitudes and behaviours, general health and psychological status of survivors who were affected by the 2023 Kahramanmaraş Earthquake and who were living in Nurdağı District of Gaziantep after the earthquake.

METHODS

Data of 2317 individuals older than 18 years of age who were living in earthquake neighbourhoods, tents and containers in Nurdağı District of Gaziantep were examined. Variables were evaluated to find out the demographic characteristics and general health status of earthquake victims. General Health Questionnaire (GHQ-12) was used to find out psychological states of earthquake victims.

RESULTS

The rate of injuries was 14.2% and leg and foot injuries were the most common with 44.2%. The relationship between injury status; and age, marital status, and being trapped under debris was revealed (p < 0.05). Mean GHQ-12 score of the survivors was 3.81 ± 2.81 and 51.9% experienced psychological distress. In the evaluation with logistic regression, it was found that female gender, being injured in the earthquake, loss of first degree and second degree relatives (with a higher rate in loss of first degree relative), having a severely damaged -to be demolished house and having a completely destroyed house were correlated with higher level of psychological distress (p < 0.05).

CONCLUSION

General characteristics, injury prevalence and affecting factors of earthquake survivors were evaluated in the present study. Psychological distress was found in victims. For this reason, providing protective and assistive services to fight the destructive effects of earthquake is vital. Accordingly, increasing the awareness of people residing in earthquake zones regarding earthquakes is exceptionally important.

Earthquakes from a radiological perspective: what is demanded from the radiologists, and what can we do? A pictorial review

Earthquakes are among the most destructive and unpredictable natural disasters. Various diseases and ailments, such as bone fractures, organ and soft-tissue injuries, cardiovascular diseases, lung diseases, and infectious diseases, can develop in the aftermath of severe earthquakes. Digital radiography, ultrasound, computed tomography, and magnetic resonance imaging are significant imaging modalities utilized for the quick and reliable assessment of earthquake-related ailments to facilitate the planning of suitable therapy. This article examines the usual radiological imaging characteristics observed in individuals from quake-damaged regions and summarizes the strengths and functionality of imaging modalities. In such circumstances, where quick decision-making processes are life-saving and essential, we hope this review will be a practical reference for readers.

Preventing extremity amputations after earthquakes: a quantitative analysis of fasciotomy and extrication time

PURPOSE

The purpose of this study is to evaluate the impact of prolonged extrication time and the time to fasciotomy applications on amputation requirement by giving quantitative and cutoff values.

METHODS

In this single-center study, the clinical records of patients with musculoskeletal injuries due to the 6 February Kahramanmaraş earthquake in Turkey were retrospectively reviewed. All patients who underwent fasciotomy or amputation regardless of age and gender were included in the study. 163 extremities of 140 patients who met the inclusion criteria were evaluated. Demographic data of the patients, such as age and gender, were recorded in this study. The primary outcome of this study was the correlation of the time between injury and fasciotomy applications with the amputation requirement. At the same time, the effect of prolonged extrication time of earthquake victims on amputation requirement.

RESULTS

The mean age was 29.01 ± 15.55 of earthquake victims included in the current study and the gender distribution of the patients is almost equal. 87 amputations of 65 patients were performed and transtibial amputation was the most common type (41.3%). The mean fasciotomy time was 38.78 ± 23.64 h. Delayed fasciotomies performed after 45.5 h increase 28.48 times the amputation requirement. The mean extrication time in the current study was 36.49 h. The patients with extrication time longer than 23 h was associated with an 8.8 times higher risk of amputation.

CONCLUSIONS

Authors believe that knowledge of the relationship between earthquake survivors' prognosis and time of extrication, as well as the impact of fasciotomy timing on extremity loss, is essential for a more successful treatment management in future disasters.

The initial response of a local hospital in the earthquake zone during the February 6, 2023 Kahramanmaraş earthquakes: Injuries and challenges

OBJECTIVE

This study aimed to describe the type and number of traumatic injuries seen after devastating earthquakes and to evaluate the difficulties experienced in the treatment process in a primary affected center.

METHODS

Out of the 2176 patients who were treated in the emergency department, 372 (199 male and 173 female) patients with complete data were included in this single-center retrospective study. In addition to the demographic characteristics of the patients, orthopedic injuries, other organ system injuries, type of injury, treatments, mechanisms of injury, and time of presentation to the emergency department were recorded.

RESULTS

The most common age group for injury was 20-30 years old, consisting of 73 patients (19.62%), and the second most common age group was between 40 and 50, with 72 patients (19.35%). Injury after being trapped under rubble was seen in 152 (40.86%) patients, while non-debris causes were more common in 220 patients (59.14%). The most common site of injury was in the lower extremities, with 111 patients (29.84%), while multiple injuries were seen in 109 patients (29.3%). Lower extremity fractures were mostly seen in long bones such as the femur (12.28%) and tibia (11.4%). Upper extremity fractures, especially those due to falls, were most frequently in the distal radius (8.77%). After triage, 117 patients (31.45%) were hospitalized, whereas the majority of patients (58.33%) were discharged from the emergency department.

CONCLUSION

This study has shown us that injuries following major earthquakes are of a wide spectrum and occur in large numbers and in a very short time. Even in a well-equipped hospital that is not affected by an earthquake, there are many barriers to appropriate management. The first 24 hours after an earthquake are critical. This period should be kept in mind while organizing and taking necessary precautions, and early responses to earthquakes should be meticulously planned.

First 10 days after the 6th of February 2023 earthquake disaster: experience of an orthopedic clinic on the border of the disaster zone

BACKGROUND

The earthquake disaster that occurred on February 06, 2023, caused serious destruction and loss of life in the south of Türkiye. The purpose of this article consisting of two interconnected parts is to report the experience of our orthopedics clinic, which is located just on the border of the disaster area. The subject of the first part of the study is the characteristics of ortho-pedic traumas in earthquake victims and the treatment methods applied. The subject of the second part is the disaster work plan of the clinic and its consequences in practice.

METHODS

For the first step, descriptive information, diagnoses, and treatment methods of 204 earthquake victims who were treated by our clinic in the first 10 days after the disaster were compiled from the archives. In terms of the second phase of the study, an in-clinic work plan was created on the morning of the 1st day of the disaster. The teams and working hours in the emergency department, inpatient service, and operating room were determined. Hospital management and other clinics were contacted and hospital facilities were organized for orthopedic trauma victims.

RESULTS

The mean age of the patients was 42.3 years. Among the age groups, the smallest group was children under 10 years old (6.4% of all patients). 132 of the patients had at least one fracture in 135 extremities. Most of the injuries involved the lower extrem-ity. 66 patients had crush injury with or without fracture. 181 orthopedic surgical procedures were performed in 144 patients. The most common operations were internal fracture fixation and debridement. The most used implant was the plate-screw combination. Thanks to the in-clinic work plan and the in-hospital assistance and allocation of facilities, we did not experience serious problems in the hospitalization, surgery, and post-operative follow-ups of the patients. Although we received numerous offers of assistance from external institutions, this was not possible due to bureaucratic obstacles. Among our most important problems were the shortage of sterilized powered surgical drills and the lack of a dynamic patient information database.

CONCLUSION

Orthopedic clinics should prepare their in-clinic work plans for earthquake disasters and develop their facilities. In order not to encounter bureaucratic obstacles in emergency assistance, orthopedic clinics in different risk regions should be formally matched beforehand. A patient database table that clinical staff can access and revise using their smartphones facilitates the follow-up of large numbers of simultaneously hospitalized patients.

Hospital crisis management after a disaster: from the epicenter of 2023 Türkiye-Syria earthquake

BACKGROUND

In such cases where sudden destruction and injury are very high, search and rescue teams and hospitals can be the most important determining factors between people's lives and deaths.

METHODS

This study was conducted retrospectively, after the two catastrophic earthquakes (Türkiye-Syria Earthquakes) by taking the records of the patients who admitted to our hospital. Patients' admission times, diagnoses, demographic data, triage codes, medical interventions, hemodialysis needs, crush syndrome and mortality rates were analyzed.

RESULTS

In the first 5 days after the earthquake, 247 earthquake-related patients were admitted to our hospital. The most intense period of admission to the emergency department was the first 24 h. The most intensive period of surgical procedures was 24-48 h. It was observed that Orthopedic surgical procedures were applied most frequently and the most common cause of mortality was crush syndrome.

CONCLUSION

In terms of preparations for earthquakes, especially in hospitals in the earthquake zone it will be beneficial for each hospital to make hospital disaster plans. For this reason, we thought it would be useful to share our experiences during this disaster.

Hyperbaric oxygen therapy does not change the amputation level in patients with fasciotomy after an earthquake: Our single-center experience after 2023 Kahramanmaras earthquake

OBJECTIVES

This study aims to evaluate the effect of hyperbaric oxygen therapy (HBOT) on the amputation level in patients undergoing fasciotomy with a Mangled Extremity Severity Score (MESS) score of ≥7 after 2023 Kahramanmaras earthquake.

PATIENTS AND METHODS

Between February 6th, 2023 and March 10th, 2023, a total of 23 patients (14 males, 9 females; mean age: 36.8±13.2 years; range, 17 to 64 years) who needed amputation with a MESS score of ≥7 and refused amputation were included in the study. All fasciotomies were performed in an external center, and five of them was incomplete. First, incomplete fasciotomies were completed with debridement due to deep muscle necrosis. Daily two HBOT sessions were performed for the first three days. In the following days, daily one HBOT session was performed. The HBOT was terminated for the patients who were decided by the council that they did not benefit from HBOT treatment.

RESULTS

Six (26.08%) of the patients had a bone fracture (n=2 forearm, n=1 femur, n=2 tibia, and n=1 ankle fracture). The mean number of HBOT session was 13.24±5.4 (range, 7 to 30) and the mean duration of HBOT was 26.5±10.8 (range, 14 to 60) h. The mean MESS score was 9.96±1.36 (range, 7 to 12). All of the patients were trapped under the rubble with a mean time of 12.3±5.4 (range, 6 to 23) h. All fasciotomies were performed within the first 30 h. Twenty-two of the patients were amputated at the level previously determined by the experienced trauma surgeons. The amputation level changed in only one patient. After 38 h of HBOT, transradial amputation was performed to the patient in whom transhumeral amputation level was determined previously. None of the patients had any adverse event related to HBOT.

CONCLUSION

Our study results suggest that the MESS is a useful scoring system for amputation decision after a high-energy trauma, such as an earthquake, with a high accuracy rate. The outcomes of HBOT are not satisfactory for high-energy traumas, such as earthquakes, in those requiring fasciotomy having more muscle necrosis and a MESS score of ≥7.

The Outcome of Orthopedics Treatment of Lombok Earthquake Victim 2018: A Cohort of One-Year Follow-Up Study-Lesson Learned After Lombok Earthquake

Introduction

There was a magnitude 7 on the Richter scale earthquake on Lombok Island in 2018, causing more than 500 deaths. In the event of earthquakes, there is often an imbalance between overcrowding in hospitals and inadequate resources. The initial management of earthquake victims with musculoskeletal injuries is controversial, arguing over whether to utilize debridement, external or internal fixation, or conservative or operative treatment in an acute onset disaster situation. This study aims to determine the outcome of initial management after the 2018 Lombok earthquake, between immediate open-reduction and internal fixation (ORIF) and Non-ORIF procedures after one year follow-up.

Methods

This is a cohort study to evaluate radiological and clinical outcomes one year after orthopedic treatment in the Lombok earthquake 2018. The subjects were recruited from eight public health center and one hospital in Lombok in September 2019. We evaluate radiological outcomes (non/malunion and union) and clinical outcomes (infection and SF-36 score).

Results

Based on 73 subjects, the ORIF group has a higher union rate than the non-ORIF group (31.1% vs. 68.9%; p = 0.021). Incidence of infection only appeared in the ORIF group (23.5%). Clinical outcome as measured by SF36 showed the ORIF group had a lower mean of general health (p = 0.042) and health change (p = 0.039) clinical outcomes than the non-ORIF group.

Discussion

The most affected public group is the productive age with significant impact on social-economy. ORIF procedure is a major risk factor of infection in initial treatment after earthquake. Therefore, definitive operation with internal fixation is not recommended in the initial phase of a disaster. Damage Control Orthopedic (DCO) surgery protocol is the treatment of choice in acute disaster setting.

Conclusion

The ORIF group had better radiological outcomes than the non-ORIF group. However the ORIF group had higher cases of infection and lower SF-36 than the non-ORIF group. Definitive treatment in acute onset disaster setting should be prevented.

Retrospective Analysis of Injuries and Hospitalizations of Patients Following the 2009 Earthquake of L'Aquila City

The aim of this study was to investigate the injury patterns and the hospitalizations of patients who were admitted to hospital following the 2009 earthquake in the city of L’Aquila, Central Italy. To the best of our knowledge, this is the first study to analyze the patterns of earthquake-related injuries in Italy. We reviewed the hospital discharge data of 171 patients admitted to hospital within the following 96 h from the mainshock. This is an observational and descriptive study: We controlled for variables such as patient demographics, primary and secondary ICD-9-CM (International Classification of Diseases) diagnosis codes in order to identify the multiple injured patients, main type of injury that resulted in the hospital admission, discharge disposition, and average length of stay (LOS). Seventy-three percent of the 171 patients were admitted to hospital on the first day. Multiple injuries accounted for 52% of all trauma admissions, with a female to male ratio of 63% versus 37%. The most common type of injuries involved bone fractures (46.8%), while lower extremities were the most frequently affected sites (38.75%). The average LOS was 12.11 days. This study allows the evaluation of the impact of earthquake-related injuries in relation both to the health needs of the victims and to the use of the health care resources and assistance.

Physical therapy needs for patients with physical function injuries post-earthquake disasters: A systematic review of Chinese and Western literature

BACKGROUND AND PURPOSE

Over the last 500 years, the most earthquakes with 10,000 or more fatalities and the most overall fatalities have occurred in China. Physical therapists must develop a better understanding of the patient and injury types that they are likely to treat post-earthquake disasters. This systematic review of Chinese and Western literature identified the primary patients treated by physical therapists post-earthquake disasters for injuries that negatively impacted physical function, activity, and participation.

METHODS

Comparisons were made between reports of earthquakes in China and reports from the rest of the world combined.

RESULTS

Sixty-seven studies of 71,986 patients (51.8% male) at 40.6 ± 15 years of age were included. Studies were mostly prospective (n = 48, 71.6%). Reports of earthquakes in China represented more recently occurring disasters (p = .003) and more prospective research designs (p = .003). Reports from China also had a higher median fracture number (p = .004). Studies from China used manual muscle testing (p = .02), visual analogue pain scales (p = .008), Barthel index or modified Barthel index (p < .0001), and joint motion assessment (p = .007) with greater frequencies.

DISCUSSION

Physical therapists from China are more likely to treat patients with a fracture; however, physical therapists from both regions are likely to treat patients with general injuries representing poly-trauma to multiple body regions, traumatic brain-closed head injuries, spinal cord injuries, peripheral nerve injuries, and soft tissue injuries.

IMPLICATIONS ON PHYSIOTHERAPY PRACTICE

These data can help improve earthquake disaster planning, infrastructure development, and resource needs assessment effectiveness. More prospective research study designs and more recent earthquake disasters in China are likely associated with greater explicit use of valid and reliable outcome measurements such as joint motion assessment, manual muscle testing, visual analogue pain scale, and the Barthel index or modified Barthel index.

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

BACKGROUND

Earthquakes 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.

METHODS

Several 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.

RESULTS

Most 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%).

CONCLUSIONS

Orthopaedic 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.

Earthquake-Related Orthopedic Injuries in Adult Population: A Systematic Review

Introduction Earthquake-related trauma results in crush injuries and bony- and soft-tissue trauma. There are no systematic reviews analyzing the typical injury patterns and treatments in "Mega-Mass-Casualty" earthquakes. The characterization of an injury pattern specific to disaster type, be it natural or manmade, is imperative to build an effective disaster preparedness and response system.

METHODS

The systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A comprehensive search strategy was developed to identify all publications relating to earthquakes and the orthopedic treatment in adult patients. The following databases were searched: PubMed (Medline; US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA), Ovid (Ovid Technologies; New York, New York USA), Web of Science (Thomson Reuters; New York, New York USA), and The Cochrane Library (The Cochrane Collaboration; Oxford, United Kingdom).

RESULTS

The searches identified 4,704 articles: 4,445 after duplicates were removed. The papers were screened for title and abstract and 65 out of those were selected for full-text analysis. The quality of data does not permit a standard-of-care (SOC) to be defined. Scarcity and poor quality of the data collected also may suggest a low level of accountability of the activity of the international hospital teams. Qualitatively, it is possible to define that there are more open fractures during daytime hours than at night. Excluding data about open and closed fractures, for all types of injuries, the results underline that the higher the impact of the earthquake, as measured by Richter Magnitude Scale (RMS), the higher is the number of injuries. Discussion Regarding orthopedic injuries during earthquakes, special attention must be paid to the management of the lower limbs most frequently injured. Spinal cord involvement following spine fractures is an important issue: this underlines how a neurosurgeon on a disaster team could be an important asset during the response. Conservative treatment for fractures, when possible, should be encouraged in a disaster setting. Regarding amputation, it is important to underline how the response and the quality of health care delivered is different from one team to another. This study shows how important it is to improve, and to require, the accountability of international disaster teams in terms of type and quality of health care delivered, and to standardize the data collection. Bortolin M , Morelli I , Voskanyan A , Joyce NR , Ciottone GR . Earthquake-related orthopedic injuries in adult population: a systematic review. Prehosp Disaster Med. 2017;32(2):201-208.

Delayed Presentation of Gluteal Compartment Syndrome: The Argument for Fasciotomy

A male patient in his fifties presented to his local hospital with numbness and weakness of the right leg which left him unable to mobilise. He reported injecting heroin the previous morning. Following an initial diagnosis of acute limb ischaemia the patient was transferred to a tertiary centre where Computed Tomography Angiography was reported as normal. Detailed neurological examination revealed weakness in hip flexion and extension (1/5 on the Medical Research Council scale) with complete paralysis of muscle groups distal to this. Sensation to pinprick and light touch was globally reduced. Blood tests revealed acute kidney injury with raised creatinine kinase and the patient was treated for rhabdomyolysis. Orthopaedic referral was made the following day and a diagnosis of gluteal compartment syndrome (GCS) was made. Emergency fasciotomy was performed 56 hours after the onset of symptoms. There was immediate neurological improvement following decompression and the patient was rehabilitated with complete nerve recovery and function at eight-week follow-up. This is the first documented case of full functional recovery following a delayed presentation of GCS with sciatic nerve palsy. We discuss the arguments for and against fasciotomy in cases of compartment syndrome with significant delay in presentation or diagnosis.

Quality orthopaedic care in sudden-onset disasters: suggestions from Médecins Sans Frontières-France

A huge change is needed in the conception and implementation of surgical care during sudden-onset disasters (SOD). The inadequate surgical response mounted by the majority of foreign medical teams (FMT) after Haiti's earthquake is a striking example of the need for a structured professional approach. Logistical capacity already exists to provide safe, timely, effective, efficient, equitable and ethical patient-centred care with minimum standards. However, knowledge, skills and training in the fields of general, orthopaedic and plastic surgery need further clarification. Surgical activity data and clinical examples from several Médecins Sans Frontières-France (MSF) projects are used here to describe the skill set and experience essential for surgeons working in SOD contexts.

Surgical Management of Musculoskeletal Injuries after 2015 Nepal Earthquake: Our Experience

We report our experience of handling 80 major musculoskeletal injuries in a brief span of three days immediately after the major earthquake of Nepal in April 2015. Planning, proper utilization of resources, and prioritizing the patients for surgical intervention is highlighted. The value of damage control by orthopaedics in these disasters is discussed. Timely and appropriate surgical treatment by a skilled orthopaedic team not only can save these injured limbs but also the lives of the victims of a major disaster.

Performed Surgical Interventions After the 1999 Marmara Earthquake in Turkey, and Their Importance Regarding Nursing Practices

Effectively dealing with earthquakes is especially important for the people who live in areas prone to earthquakes such as the country of Turkey. Trauma related to earthquakes has specific relevance to nursing practice. The purpose of this review was to describe the types of surgical interventions after the Marmara earthquake and to evaluate the implications for nursing care. English and Turkish articles about the Marmara earthquake were reviewed between May and July 2013. A total of 7 studies were evaluated. The number of patients admitted to the units, types of injuries, and surgical treatments were recorded, with a total of 2378 patients with earthquake-related injuries. The most commonly traumatized parts of the body were the extremities. Fasciotomy operations were performed on 286 patients and 75 patients underwent extremity amputations. Predetermining surgical problems and interventions may be useful in planning for possible future problems in the case of a disaster.

Disaster nephrology: crush injury and beyond

Disasters result in a substantial number of renal challenges, either by the creation of crush injury in victims trapped in collapsed buildings or by the destruction of existing dialysis facilities, leaving chronic dialysis patients without access to their dialysis units, medications, or medical care. Over the past two decades, lessons have been learned from the response to a number of major natural disasters that have impacted significantly on crush-related acute kidney injury and chronic dialysis patients. In this paper we review the pathophysiology and treatment of the crush syndrome, as summarized in recent clinical recommendations for the management of crush syndrome. The importance of early fluid resuscitation in preventing acute kidney injury is stressed, logistic difficulties in disaster conditions are described, and the need for an implementation of a renal disaster relief preparedness program is underlined. The role of the Renal Disaster Relief Task Force in providing emergency disaster relief and the logistical support required is outlined. In addition, the importance of detailed education of chronic dialysis patients and renal unit staff in the advance planning for such disasters and the impact of displacement by disasters of chronic dialysis patients are discussed.

Study of the severity of musculoskeletal injuries and triage during the 2005 Pakistan earthquake

PURPOSE

On 8 October 2005 a massive earthquake hit the northern mountainous areas of Pakistan and Kashmir causing 73,338 deaths and leaving over 125,000 severely injured. In a region which was less prepared for such an enormous disaster, mobilising rescue, relief and rehabilitation posed great challenges. The first author (SMA) established two level 1 orthopaedic trauma and rehabilitation units in each of two severely hit major cities through private philanthropy. According to the severity of injuries, the patients were triaged and treated. The aim of this study is to improve the future strategies in similar scenarios.

METHODS

This is a retrospective review of medical records of patients suffering from musculoskeletal injuries in the aftermath of the 2005 earthquake who were managed in these centres in the order of triage priority. The patients were received, categorised, worked up and provided definitive surgical procedures. All patients were provided assistance for the fitting of a prosthesis and rehabilitation.

RESULTS

Of 128,304 (total of injured patients), 19,700 were managed in two centres established by SMA during the first months after the earthquake. Of these, 112 patients underwent amputations of upper and lower limbs.

CONCLUSIONS

In a massive calamity over a wide geographical area away from big university hospitals, such as the 2005 Pakistan earthquake, the level 1 operating theatre facilities must be established within the area to meet the immediate needs of the patients nearest to their homes and families, and run forever so that patients can have excellent follow-up and can use the same facilities regularly. In the aftermath of this earthquake the need to practise triage in the first 72 hours was thoroughly realised and effectively practised in our centres.

The christchurch earthquake: crush injury, neuropathic pain, and posttraumatic stress disorder

On February 22, 2011, an earthquake of magnitude 6.3 struck Christchurch, New Zealand. The peak ground acceleration, a measure of the shaking or intensity of an earthquake, was one of the highest ever recorded worldwide. One hundred and eighty-five people lost their lives; many others were injured. Two cases both involving young women are presented; they sustained crush injuries to limbs after being trapped by falling debris and went on to develop severe neuropathic pain. This report examines the mechanisms of neuropathic pain in the setting of crush injury, the treatment modalities, and the association between chronic pain and posttraumatic stress disorder. These case reports highlight the fact that crush injury is relatively common during major earthquakes and that neuropathic pain is an important sequel of this. Post-traumatic stress disorder is common in earthquake survivors with a recognised association with chronic pain. Pain-related disability may increase as well. Issues such as chronic pain and physical disability should not be overlooked as attention focuses on disaster management and the treatment of life-threatening injuries.