Analysis of long bone injuries in earthquake of 2005 Pakistan

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Analysis of long bone injuries in earthquake of
2005 Pakistan

• Dr.Rizwan Akram
• FCPS(Orth)
• Assistant Professor
• DEPARTMENT OF ORTHOPAEDICS SPINE SURGERY,
  LAHORE MEDICAL DENTAL COLLEGE/
• GHURKI TRUST TEACHING HOSPITAL, LAHORE, PAKISTAN.

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Ghurki Trust Teaching Hospital
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The A Team
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Scale of Destruction
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THE GHURKI (Trust) HOSPITAL RESPONSE

• Responded quickly--- First team comprising 02
  Orthopaedic consultants, 02 residents and 02 OTAs
  left within 10 hours of disaster.
• Within 72 hours, a FIELD HOSPITAL was established
  in Muzaffarabad in tents containers, with
  patients in tents and 02 ORs, an X- ray room and
  a Laboratory in containers.
• A protocol formulated--- Spine Pelvis injury
  patients to GTTH Lahore while Limb injury
  patients to be treated locally.

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• LATER---- Four teams formed--- Each comprising 01
  consultant, 03 residents, 02 final year female
  students, 02 OTAs, a physiotherapist, a
  laboratory technician, a radiographer a ward
  cleaner.
• The only operating facility in the whole of
  Muzaffarabad for the first two weeks after
  disaster.
• Teams provided round the clock cover from
  09-10-2005 to 07-01-2006 (91 days).

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Emergency Mobile Theatre in Container
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Surgeon Anaesthesia offices
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FIRST INTRAMEDULLARY INTERLOCKING NAIL IN
MUZAFARABAD
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A-Team Effort
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POST-OPERATIVE
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SIGN NAIL
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SIGN NAIL TIBIA
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SIGN NAIL DEMONSTRATION TO U.S. ARMY SURGEON
(MASH)
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Amputation advised limbs saved!
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Pelvic femur fixation done
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Pelvic fixation with external fixator
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Objective

• The extremity injury pattern after a major
  earthquake is not well understood because data on
  this is not available
• Aim of this study was to analyze the data of
  trauma patients with extremity injury in the
  earthquake of Azad Kashmir 2005, registering 7.6
  on the Richter scale.

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FIELD HOSPITAL MUZAFFARABAD RECORD

• 330 patients record was reviewed for injury
  pattern
• 270 patients found to have limb injuries
• Comprising 136 females and 134 males
• Majority were under the age of 40yrs(77.7)

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Results

• The most common sites of injury was lower
  extremity (185/270 patients, 68.5).
• Fracture was the major type of injury 157/270
  patients.(58.4 of extremity injuries).
• Pelvic and rib fractures and abdominal injuries
  were the most frequently associated injuries.
• Amputation and death occurred in 2.9 and 2.5 of
  cases, respectively.

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• We have provided Modular implants for the
  amputees (144) in collaboration with Govt Of
  Japan free of cost

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Injury Pattern
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The most common sites of injury was lower
extremity (185/270 patients, 68.5).
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Fracture was the major type of injury 157/270
patients.(58.4 of extremity injuries).
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Conclusions

• Limb injuries are the most frequent injuries in a
  mass disaster situation.
• Special attention should be given to dealing with
  orthopedic injuries in similar situation in
  future.

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RECOMMENDATIONS
LOCAL

• All future relief/rehabilitation should be
  completely organized.
• Allocate areas to different teaching hospitals---
  Complete care/treatment till rehabilitation.
• Reconstruction of infrastructure should be
  preferred.

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International

• There should be a comprehensive evacuation plan.
  
• International Disaster Management Team. (Like
  Inter-pol)
• Pre-allocation of regions in the continents
• Frequent Global Rehearsals.
• Global Fund / Trust? (Like SIGN)

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Any Question ?
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Summary

• Orthopaedic Injuries are the common injuries in
  this type of disaster (EARTHQUAKE)
• Survivors required Orthopaedic help
• Surgical and Neurosurgical patients usually do
  not survive (evacuation delay)
• First responder Team should include Orthopaedic
  Surgeon.