War-related extremity injuries in children: 89 cases managed in a combat support hospital in Afghanistan - 29/03/15

Doi : 10.1016/j.otsr.2015.02.003

A. Bertani ^a,^⁎ , L. Mathieu ^b, J.-L. Dahan ^c, F. Launay ^d, F. Rongiéras ^e, S. Rigal ^f
^a Service de chirurgie orthopédique, HIA Desgenettes, Lyon, France
^b Service de chirurgie orthopédique, HIA Percy, Clamart, France
^c Service de réanimation, HIA Percy, Clamart, France
^d Service d’orthopédie infantile, CHU Timone, Marseille, France
^e Service de chirurgie orthopédique, Military Teaching Hospital Desgenettes, Lyon, France
^f Chaire de chirurgie de guerre, French Military Health Service Academy, Paris, France

^⁎Corresponding author. Service de chirurgie orthopédique, HIA Desgenettes, 69003 Lyon, France.

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Abstract

Background

Meeting paediatric needs is among the priorities of western healthcare providers working in Afghanistan.

Hypothesis

Insufficient information is available on paediatric wartime injuries to the extremities. Our objective here was to describe these injuries and their management on the field.

Materials and methods

We retrospectively reviewed consecutive cases of injuries to the extremities in children (<16 years of age) due to weapons and managed at the Kabul International Airport (KaIA) Combat Support Hospital between June 2009 and April 2013. We identified 89 patients with a mean age of 10.2±3.5 years and a total of 137 elemental lesions.

Results

Explosive devices accounted for most injuries (78.6%) and carried a significantly higher risk of multiple lesions. There were 54 bone lesions (traumatic amputations and fractures) and 83 soft-tissue lesions. The amputation rate was 18%. Presence of bone lesions was associated with a higher risk of injury to blood vessels and nerves. Of the 89 patients, four (4.5%) died and eight (9%) were transferred elsewhere. Of the 77 remaining patients, at last follow-up (median, one month; range, 0.1–16 months), 73 (95%) had achieved a full recovery (healed wound and/or fracture) or were recovering with no expectation that further surgery would be needed.

Discussion

Despite the absence of paediatric surgeons, the combat support hospital provided appropriate care at the limb salvage and reconstruction phases. The highly specialised treatments needed to manage sequelae were very rarely provided. These treatments probably deserve to be developed in combat support hospitals.