Abstract
AimThe purpose of this series of cases was to analyse our management of orthopaedic trauma casualties in the Libyan civil war crisis in the European summer of 2014. We looked at both damage control orthopaedics and for case variety of war trauma at a civilian hospital. Due to our geographical proximity to Libya, Malta was the closest European tertiary referral centre. Having only one Level 1 trauma care hospital in our country, our Trauma and Orthopaedics department played a pivotal role in the management of Libyan battlefield injuries. Our aims were to assess acute outcomes and short term mortality of surgery within the perspective of a damage control orthopaedic strategy whereby aggressive wound management, early fixation using relative stability principles, antibiotic cover with adequate soft tissue cover are paramount. We also aim to describe the variety of war injuries we came across, with a goal for future improvement in regards to service providing.MethodsProspective collection of six interesting cases with severe limb and spinal injuries sustained in Libya during the Libyan civil war between June and November 2014.ConclusionsWe applied current trends in the treatment of war injuries, specifically in damage control orthopaedic strategy and converting to definitive treatment where permissible. The majority of our cases were classified as most severe (Type IIIB/C) according to the Gustilo-Anderson classification of open fractures. The injuries treated reflected the type of standard and improved weaponry available in modern warfare affecting both militants and civilians alike with increasing severity and extent of damage. Due to this fact, multidisciplinary team approach to patient centred care was utilised with an ultimate aim of swift recovery and early mobilisation. It also highlighted the difficulties and complex issues required on a hospital management level as a neighbouring country to war zone countries in transforming care of civil trauma to military trauma.
Highlights
Malta has been closely involved in the Libyan civil conflict on a geographical, political and humanitarian level since its inception around the year 2011, commonly referred to as the ‘Arab Spring’
The injuries treated reflected the type of standard and improved weaponry available in modern warfare affecting both militants and civilians alike with increasing severity and extent of damage
Multidisciplinary team approach to patient centred care was utilised with an ultimate aim of swift recovery and early mobilisation
Summary
Malta has been closely involved in the Libyan civil conflict on a geographical, political and humanitarian level since its inception around the year 2011, commonly referred to as the ‘Arab Spring’. Due to our geographical proximity, as one of Libya’s closest European neighbouring countries, Malta received both civilian refugees and military casualties of war. Ng et al Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (2015) 23:103 country in civil war is paralleled to the Akkucuk et al (2015) [1], in their paper reporting their experience from Turkey bordering the civil war stricken Syria in which a Level 1 civilian trauma centre became a military trauma centre. The current basic war surgery principles advocated worldwide, consist of aggressive resuscitation, early and thorough debridement of the wounds, short term bridging procedures to achieve stability, rapid evacuation to centre for definitive treatment [1, 6]
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