A review of the epidemiology and treatment of orthopaedic injuries after earthquakes in developing countries
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REVIEW
Open Access
A review of the epidemiology and treatment of orthopaedic injuries after earthquakes in developing countries James S. MacKenzie1, Bibek Banskota2, Norachart Sirisreetreerux1,3, Babar Shafiq1 and Erik A. Hasenboehler1,4*
Abstract 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. Keywords: Developing countries, Earthquake, Epidemiology, Orthopaedic injury
Background Since 2000, major earthquakes have taken more than 800,000 lives and injured countless more [1]. As defined by the Centre for Research on the Epidemiology of Disasters, the mean number of “major” earthquakes annually (defined as causing more than 10 deaths, affecting more than 100 people, and resulting in international aid or declaration of a state of emergency) was 21 from 1970 to 2005 [2, 3]. From 2000 to 2005, that mean * Correspondence: [email protected] 1 Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore 21287, MD, USA 4 Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave., #A667, Baltimore 21224-2780, MD, USA Full list of author information is available at the end of the article
increased to more than 30 because of increasing population density in seismically active regions [2]. Figure 1 shows the number of earthquake disasters by country from 1974 to
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