Treatment of secondary hip arthritis from shell fragment and gunshot injury in the Syrian civil war
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(2020) 15:464
RESEARCH ARTICLE
Open Access
Treatment of secondary hip arthritis from shell fragment and gunshot injury in the Syrian civil war Raif Özden* , Serkan Davut, Yunus Doğramacı, Aydıner Kalacı, İbrahim Gökhan Duman and Vedat Uruç Abstract Background: In gunshot and shell fragment injuries to the hip joint, orthopedic intervention includes wound assessment and care, osteosynthesis of fractures, and avoiding of infection and osteoarthritis. Individuals injured in the Syrian civil war were frequently transferred to the authors’ institution in neighboring city. Orthopedic trauma exposures were determined in approximately 30% of these patients. The aim of this study was to evaluate the outcomes of the patients with secondary hip arthritis due to prior gunshot and shell fragment (shrapnel) injuries who underwent primary total hip arthroplasty. Methods: This retrospective study reviewed 26 patients (24 males, 2 females) who underwent hip arthroplasty due to prior gunshot and shell fragment injuries from November 2013 to January 2019. For all patients, the Harris Hip Score (HHS) was evaluated preoperatively and after surgery. Results: Mean age was 31.5 (range, 19–48) years. The mean preoperative HHS was 52.95 points, and the mean postoperative HHS was 79.92 points at the final follow-up after surgery. Patients with shell fragment injuries to the hip joint had higher infection rates, but it is not statistically significant. Conclusions: An anatomic reduction of the fracture may not be possible in these cases as a result of significant bone and/or cartilage loss. Total hip arthroplasty can be done after gunshot- and shell fragment-related posttraumatic arthritis. It is an effective treatment choice to reduce pain and improve function, but the surgeon must be very careful because of high rate of infection. Keywords: Arthroplasty, Hip gunshot, Secondary hip osteoarthritis, Shell fragment injuries
Background Gunshot wounds to the hip joint constitute 2% of all extremity and 4% of lower extremity injuries. If nonarticular wounds to the hip area are included, these percentages increase to 9% and 17%, respectively [1]. Due to the social and medical problems associated with civilian war, millions of refugees had to immigrate to the neighboring countries [2]. Until March 2016, it has been estimated that the total number of recorded and unrecorded * Correspondence: [email protected] Department of Orthopaedics and Traumatology, Faculty of Medicine, Mustafa Kemal University, Serinyol, 31001 Antakya, Hatay, Turkey
refugees reached 2.7 million in our country [3]. Individuals injured in the Syrian civil war were frequently transferred to the authors’ institution in neighboring city. Most of the cases admitted to general surgery department, division of neurosurgery, and department of orthopedics of the same hospital [4, 5]. Orthopedic trauma exposures were determined in approximately 30% of these patients [6]. Between 2011 and 2019, 10,006 cases were treated in the department of orthopedics. Of these, 276 adult patients had
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