Abstract
Purpose
In the 2005 Pakistan earthquake, the great many injured with multiple fractures and open wounds provided a unique opportunity to practice damage-control orthopaedics. External fixators remain a time-tested tools for operating surgeons on such occasions. The locally manufactured, readily available Naseer-Awais (NA) external fixator filled such needs of this disaster with good outcome.
Methods
This is a retrospective descriptive study of 19,700 patients that presented over seven months to the two centres established by the lead author (SMA) in Muzaffarabad and Mansehra just one night after the 2005 earthquake. A series of local and foreign orthopaedic surgeon teams operated in succession. The computerised patient data collection of 1,145 operations was retrospectively analysed.
Results
Of the 19,700 patients presenting to the SMA centres, 50 % had limb injuries. Total fracture fixations were 1,145, of which 295 were external fixations: 185 were applied on the lower limb and 90 on upper limb, the majority were applied on tibia.
Conclusion
External fixators are valuable damage-control tools in natural disasters and warfare injuries. The locally manufactured NA external fixator served the needs of the many limb injuries during the 2005 Pakistan earthquake.
Similar content being viewed by others
References
Awais SM, Dar UZ, Saeed A (2012) Amputations of limbs during the 2005 earthquake in Pakistan: A firsthand experience of the author. Int Orthop 36:2323–2326
Ali I, Mir AA, Jabeen R, Ahmad M, Fazili A, Kaul R-uR (2010) Morbidity pattern and impact of rehabilitative services in earth quake victims of kashmir, india. Int J Health Sci 4:59
X-d BAI, X-h LIU (2009) Retrospective analysis: The earthquake-injured patients in barakott of Pakistan. Chin J Traumatol (Engl Ed) 12:122–124
Awais S, Saeed A (2013) Study of the severity of musculoskeletal injuries and triage during the 2005 Pakistan earthquake. Int Orthop 37:1443–1447
Yasin MA, Malik SA, Nasreen G, Safdar CA (2009) Experience with mass casualties in a subcontinent earthquake. Ulus Travma Acil Cerrahi Derg 15:487–492
Mulvey J, Awan S, Qadri A, Maqsood M (2008) Profile of injuries arising from the 2005 kashmir earthquake: The first 72 h. Injury 39:554–560
Covey DC (2006) Combat orthopaedics: A view from the trenches. J Am Acad Orthop Surg 14(10):S10–7
Gordon WT, Grijalva S, Potter BK (2012) Damage control and austere environment external fixation: Techniques for the civilian provider. J Surg Orthop Adv 21:22
Hinsenkamp M (2013) Sicot contribution to natural disaster assistance: The triage. Int Orthop 37:1427–1428
Pape H-C, Hildebrand F, Pertschy S, Zelle B, Garapati R, Grimme K, Krettek C (2002) Changes in the management of femoral shaft fractures in polytrauma patients: From early total care to damage control orthopedic surgery. J Trauma-Injury Infect Crit Care 53:452–462
Scalea TM, Boswell SA, Scott JD, Mitchell KA, Kramer ME, Pollak AN (2000) External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fractures: Damage control orthopedics. J Trauma 48(4):613–21
Taeger G, Ruchholtz S, Waydhas C, Lewan U, Schmidt B, Nast-Kolb D (2005) Damage control orthopedics in patients with multiple injuries is effective, time saving, and safe. J Trauma-Injury Infect Crit Care 59:408–415
Tuttle MS, Smith WR, Williams AE, Agudelo JF, Hartshorn CJ, Moore EE, Morgan SJ (2009) Safety and efficacy of damage control external fixation versus early definitive stabilization for femoral shaft fractures in the multiple-injured patient. J Trauma Acute Care Surg 67:602–605
Behrens F (1989) General theory and principles of external fixation. Clin Orthop Relat Res 241:15–23
Behrens F, Searls K (1986) External fixation of the tibia. Basic concepts and prospective evaluation. J Bone Joint Surg Br Vol 68:246–254
Fragomen AT, Rozbruch SR (2007) The mechanics of external fixation. HSS J 3:13–29
Awais Syed Muhammad NM (1992) Leg lengthening with naseer-awais fixator. J Pak Ortho Assoc 2
Awais Syed Muhammad NMJPOA (1992) Management of segmental defects by intercalary bone transport using naseer - awais external fixation. J Pak Ortho Assoc 2:97–105
Shabir M, Arif M, Satar A, Inam M (2010) Distraction osteogenesis in segmental bone defects in tibia by monoaxial external fixator. JPMI: J Postgrad Med Inst 24:
Helminen M, Saarela E, Salmela J (2006) Characterisation of patients treated at the red cross field hospital in kashmir during the first three weeks of operation. Emerg Med J 23:654–656
Lebel E, Blumberg N, Gill A, Merin O, Gelfond R, Bar-On E (2011) External fixator frames as interim damage control for limb injuries: Experience in the 2010 haiti earthquake. J Trauma Acute Care Surg 71:E128–E131
Sonshine DB, Caldwell A, Gosselin RA, Born CT, Coughlin RR (2012) Critically assessing the haiti earthquake response and the barriers to quality orthopaedic care. Clin Orthop Relat Res 470:2895–2904
Brennan RJ, Waldman RJ (2006) The south asian earthquake six months later—an ongoing crisis. N Engl J Med 354:1769–1771
Calder J, Mannion S (2005) Orthopaedics in sri lanka post-tsunami. J Bone Joint Surg Br Vol 87:759–761
Pape H-C, Tornetta P, Tarkin I, Tzioupis C, Sabeson V, Olson SA (2009) Timing of fracture fixation in multitrauma patients: The role of early total care and damage control surgery. J Am Acad Orthop Surg 17:541–549
Barfod C, Danker J, Forberg J, Lauritzen MM (2010) The distribution of triage categories and the impact of emergency symptoms and signs on the triage level. Scand J Trauma Resuscitation Emerg Med 18:P34
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Awais, S., Saeed, A. & Ch, A. Use of external fixators for damage-control orthopaedics in natural disasters like the 2005 Pakistan earthquake. International Orthopaedics (SICOT) 38, 1563–1568 (2014). https://doi.org/10.1007/s00264-014-2436-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-014-2436-5