Evidence map›Paper›PMID 38658929›Full record

ArticleConflict and health2024

The integration of ortho-plastic limb salvage teams in the humanitarian response to violence-related open tibial fractures: evaluating outcomes in the Gaza Strip.

Theresa Farhat, Krystel Moussally, Hasan Nahouli, Shahd Abu Hamad, Khulood Abul Qaraya, Zahi Abdul-Sater, Walaa G El Sheikh, Nadine Jawad, Khouloud Al Sedawi, Mohammed Obaid and 6 more

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PubMed Full text at PMC Publisher
In one paragraph

Article in Conflict and health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Theresa Farhat *Global Health Institute, American University of Beirut, Gefinor Center Block D, 3rd floor, P.O. Box 11-0236, Riad El Solh, Beirut, 1107-2020, Lebanon.
Krystel Moussally *Médecins Sans Frontières, Lebanon Branch Office, Middle East Medical Unit, Beirut, Lebanon.
Hasan NahouliDivision of Orthopedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
Shahd Abu HamadGlobal Health Institute, American University of Beirut, Gefinor Center Block D, 3rd floor, P.O. Box 11-0236, Riad El Solh, Beirut, 1107-2020, Lebanon.
Khulood Abul QarayaGlobal Health Institute, American University of Beirut, Gefinor Center Block D, 3rd floor, P.O. Box 11-0236, Riad El Solh, Beirut, 1107-2020, Lebanon.
Zahi Abdul-SaterGlobal Health Institute, American University of Beirut, Gefinor Center Block D, 3rd floor, P.O. Box 11-0236, Riad El Solh, Beirut, 1107-2020, Lebanon.
Walaa G El SheikhClinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon.
Nadine JawadGlobal Health Institute, American University of Beirut, Gefinor Center Block D, 3rd floor, P.O. Box 11-0236, Riad El Solh, Beirut, 1107-2020, Lebanon.
Khouloud Al SedawiOperational Centre Brussels, Gaza mission, Médecins Sans Frontières, Gaza, Palestine.
Mohammed ObaidOperational Centre Brussels, Gaza mission, Médecins Sans Frontières, Gaza, Palestine.
Hafez AbuKhoussaOperational Centre Brussels, Gaza mission, Médecins Sans Frontières, Gaza, Palestine.
Innocent NyaruhiriraOperational Centre Brussels, Medical Department, Médecins Sans Frontières, Brussels, Belgium.
Hani TamimClinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon.
Shehan HettiaratchyCentre for Blast Injury Studies, Imperial College London, London, UK.
Anthony M J BullCentre for Blast Injury Studies, Imperial College London, London, UK.
Ghassan Abu-SittahGlobal Health Institute, American University of Beirut, Gefinor Center Block D, 3rd floor, P.O. Box 11-0236, Riad El Solh, Beirut, 1107-2020, Lebanon. ga60@aub.edu.lb.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundLimb salvage by ortho-plastic teams is the standard protocol for treating open tibial fractures in high-income countries, but there's limited research on this in conflict settings like the Gaza Strip. This study assessed the clinical impact of gunshot-related open tibial fractures, compared patient management by orthopedic and ortho-plastic teams, and identified the risk factors for bone non-union in this context.

methodsA retrospective review of medical records was conducted on Gaza Strip patients with gunshot-induced-open tibial fractures from March 2018 to October 2020. Data included patient demographics, treatments, and outcomes, with at least one year of follow-up. Primary outcomes were union, non-union, infection, and amputation.

resultsThe study included 244 injured individuals, predominantly young adult males (99.2%) with nearly half (48.9%) having Gustilo-Anderson type IIIB fractures and more than half (66.8%) with over 1 cm of bone loss. Most patients required surgery, including rotational flaps and bone grafts with a median of 3 admissions and 9 surgeries. Ortho-plastic teams managed more severe muscle and skin injuries, cases with bone loss > 1 cm, and performed less debridement compared to other groups, though these differences were not statistically significant. Non-union occurred in 53% of the cases, with the ortho-plastic team having the highest rate at 63.6%. Infection rates were high (92.5%), but no significant differences in bone or infection outcomes were observed among the different groups. Logistic regression analysis identified bone loss > 1 cm, vascular injury, and the use of a definitive fixator at the first application as predictors of non-union.

conclusionsThis study highlights the severity and complexity of such injuries, emphasizing their significant impact on patients and the healthcare system. Ortho-plastic teams appeared to play a crucial role in managing severe cases. However, further research is still needed to enhance our understanding of how to effectively manage these injuries.

Indexed as

ConflictGazaGunshot woundsLimb salvageLower extremityOpen tibial fractureOrtho-plasticPalestineWar

Identifiers

PMID38658929
PMCPMC11040898

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.