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    Major musculoskeletal injuries and applied treatments in the current conflicts in Syria
    (Acta Medica Mediterranea, 2014) Uruc, Vedat; Ozden, Raif; Duman, Ibrahim Gökhan; Dogramaci, Yunus; Yengil, Erhan; Karapinar, Serhat; Karakus, Ali
    Aims: The aim of this study was to document the types of musculoskeletal injuries, mechanism of injuries and applied treatments during the Syrian civil war. Materials and methods: 579 (520 male, 59 female) Syrian civilian war victims who were treated in our clinic from December 16, 2011 till August 17, 2013. The mean age was 30 years (range: 1-90 years). Anatomic distribution and mechanism of injuries, and applied treatments were the main outcomes. Results: 449 subjects were wounded by gunshot, 44 by blast injuries and 86 by other causes. 668 open fractures and 98 closed fractures were treated. 514 grade 3a open fractures which were relatively clean and early-admitted were treated as immediate aggressive debridement and internal fixation. Early infection rate was 2.7% (n=14). Eight subjects had 10 grade 3b open fractures. Seventy patients presented with 99 grade 3c open fractures. Totally 84 external fixations were applied. 138 major amputations were done in 69 subjects. Wound infections were seen in 77 patients (13.2%). 29 of them were previously operated under non-sterile conditions in Syria. Debridement & irrigation (D&I) was the most commonly applied treatment. Conclusion: In conclusion gunshot was the main wounding agent in the recent Syrian conflicts, D&I was the most commonly applied treatment. In the treatment of relatively clear and early arrived grade 3a open fractures, internal fixation, after aggressive debridement and irrigation, resulted with low infection rates and it can be considered as a good choice of treatment. Prior interventions under non-sterile conditions were associated with 63% of resistant infections and extend the duration of hospital stay. Early evacuation and thorough debridement will result in lower infection rates.