Risk factors, classification, and operative choices of femur fractures at a Tertiary Hospital: first report from Somalia.

A traumatic femur fracture is a significant cause of morbidity, affecting one to three million individuals annually. The present is the first study investigated the epidemiological characteristics, risk factors, classification, mechanisms of injury, and early management of femoral fractures in Somalia. This retrospective epidemiological study included all patients with a femur fracture who were admitted for four years between November 2018 and December 2022 to the orthopedic and trauma surgery department. We reviewed patient demographic characteristics, including age and gender, the mechanism of injury, injury characteristics, and the type of fixation performed. We reviewed the radiographs and classified the fracture using the AO/OTA classification system. During the study period, a total of 402 patients were treated for femur fractures; 256 (64%) were males, and 144 (36%) were females. The mean patient age was 47.7 ± 8.5 years. Regarding the anatomical location of femur fractures, the proximal (31A, 31B) was the most common, accounting for 50% of the patients. Femur neck fracture (31B) was the most common in the proximal femur fractures. Gunshot 82 (59.42%) was the leading cause of femur shaft fractures. Most patients with femur shaft fractures were males; 150 (86.20%) and 152 (64.47%) were young patients between 19 and 40 years old. Almost half of the patients (86) with femur shaft fractures had open fractures. The distribution of the mechanism of injury significantly differed according to age (p < 0.001). Younger patients (< 40 years) were predominantly injured due to gunshot injuries compared to elderly cases (> 60 years), where falls from standing height were the primary mechanism of injuries. There was a statistically significant difference between the mechanism of injury and gender categories (p < 0.001). Male patients were injured mainly by gunshots in about 40%, while 80% of fractures in female patients were due to falls from standing height. Female fractures occurred primarily in the proximal, while the males had an equal fracture rate for proximal and shaft fractures. Femur fracture causes significant morbidity and mortality. The study findings revealed that the most common femur fracture type was femur neck fracture, and low-energy injuries were the most common mode of injury in the elderly. Proximal femur fractures occur in older age and mainly in females. Gunshots were the most common cause of femur shaft fractures in Somalia, a country that has struggled with wars for over 30 years.

Epidemiological characteristics and comparative outcome of blast versus gunshot injuries of the extremities in Somalia.

BACKGROUND: War conflicts and terror-related injuries constitute a significant public health problem in Somalia. We aim to characterize and compare the injury characteristics of gunshot and blast injuries of the extremities. METHODS: The data of 333 patients with gunshot and blast injuries of the extremities over three years were retrospectively reviewed. The demographics, injury characteristics, and outcomes were analyzed. RESULTS: Most of the patients had injuries due to gunshot casualties compared with blast victims (n = 222, 66.7% vs. n = 111, 33.3%). Patients with gunshot wounds (GSW) had a more significant proportion of males than those with blast wounds (BW) (95.5% vs. 85.6%, P < 0.001). There were more open extremity fractures in GSW casualties (96.4% vs. 81.1%). The BW victims had significantly higher associated injuries (52.3% vs. 18.5%, P < 0.001). The BW group had a higher injury severity score (ISS ≥ 16 in 55%, P < 0.001). The need for an intensive care unit (ICU) admission was significantly higher in the BW patients (18% vs. 6.3%, P < 0.001); as well as the length of hospital stay (LOS) was higher in the BW group compared with the GW patients (> 2-week hospital stay in 31% vs. 19%, P < 0.04). About a 2.7% mortality rate was observed in BW (P < 0.014). CONCLUSION: Gunshot and explosion injuries comprise the majority of war and terror-related trauma of the extremities. These injury mechanisms differ in the body regions involved, the severity of the injury, duration of hospital stay, need for ICU admission, and mortality. Assessment and management of such devastating casualties require a complex and multidisciplinary approach.

Delayed treatment of neglected open knee dislocation; case report.

INTRODUCTION AND IMPORTANCE: Traumatic open knee dislocation is a rare, severe injury characterized by severe ligamentous destruction and a high frequency of infection and neurovascular involvement. Delayed treatment of these injuries is complicated, necessitating the intervention of not only a skilled orthopedic surgeon but also a plastic surgeon. To the best of our knowledge, this is the first case of delayed open knee dislocation faced by a practicing surgeon in an underdeveloped country (Somalia) with a successful outcome. CASE PRESENTATION: A 60 years old diabetic man, presented to our emergency unit with an open wound of his left knee, due to a traffic accident three months ago. At the time, a bone healer reduced the dislocation and applied traditional medicine to cover the wound. We decided to treat the patient with vigorous debridement, gastrocnemius flap, and hybrid external fixation for arthrodesis. The patient was followed up for three months after the surgery with excellent clinical and radiological outcomes. CONCLUSION: Although treating delayed open knee dislocation injuries is challenging, using a gastrocnemius muscle flap to cover the knee joint and arthrodesis to stabilize the joint will not only prevent limb amputation but will also result in satisfactory results.

Meat grinder hand injury; case report.

INTRODUCTION AND IMPORTANCE: Meat grinder injury to the hand is not a common case but can cause a wide spectrum of injuries that are difficult to treat. Management of meat grinder hand injuries is complex and should be based on a clear understanding of principles of wound management, fracture fixation, and soft-tissue reconstruction. To our knowledge, here we reported the first case of meat grinder hand injury faced by a practicing surgeon in an underdeveloped country (Somalia) with a Successful outcome. CASE PRESENTATION: A 2-year-old boy had his right hand trapped in a meat grinder. The middle and ring fingers were severely crushed at the metacarpophalangeal joint. Under general anesthesia, all digits were reconstructed. CLINICAL DISCUSSION: Meat grinder hand injuries can result in a wide range of injuries, from simple fractures to amputations. Safe extraction of the hand is considered the most important determinant of outcomes. Preoperative antibiotics, wound irrigation, and microsurgical techniques are used in the treatment. CONCLUSION: Although treating meat grinder hand injuries is challenging, careful extraction of the hand with a metal cutting circular saw will not only prevent secondary damage but will also save time.