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Orthopedic Injuries and Their Treatment in Children During Earthquakes: A Systematic Review
Ilaria Morelli1, Maria Grazia Sabbadini2, Michelangelo Bortolin1
11Orthopaedics and Traumatology Department,Vita-Salute San Raffaele University - San Raffaele Hospital,Milan,Italy.
Insights
Pediatric orthopedic injuries from earthquakes are common, with lower limb fractures most frequent. Field hospitals need orthopedic surgeons skilled in pediatric trauma and external fixation techniques for effective care.
Area of Science:
- Orthopedic Surgery
- Pediatric Traumatology
- Disaster Medicine
Background:
- Earthquakes frequently cause orthopedic injuries in children, yet specific data and care standards are lacking.
- Existing literature on pediatric earthquake-related orthopedic trauma is scarce, necessitating a comprehensive review.
Purpose of the Study:
- To systematically review pediatric orthopedic injuries sustained during earthquakes.
- To analyze injury types, body distribution, treatments, and outcomes.
- To establish foundational data for developing care standards in disaster settings.
Main Methods:
- Systematic review of PubMed-indexed literature (1999-2014) adhering to PRISMA guidelines.
- Inclusion of studies reporting on orthopedic injuries in children (≤18 years) in English, French, Spanish, or Italian.
- Exclusion of case reports, reviews, and non-original research; dual reviewer selection of articles.
Main Results:
- Traumatic injuries accounted for 46.9%–100.0% of pediatric hospital admissions post-earthquake.
- Fractures affected 16%–53% of pediatric patients, predominantly in the lower limbs.
- Soft-tissue injuries were prevalent (55%); debridement and external fixation (EF) were common surgical interventions, with amputation rates between 5%–11%.
Conclusions:
- Field hospitals must anticipate a high volume of pediatric lower extremity fractures following earthquakes.
- External fixation (EF) is a key surgical technique for managing these injuries.
- Ensuring the availability of orthopedic surgeons experienced in pediatric traumatology is crucial for optimal disaster response.
Abstract:
Orthopedic injuries commonly affect children during earthquakes, but reports about them are rare. This setting may lead to different standards of care, but guidelines are still missing in this field. A systematic review was performed to: (1) assess type and body distribution of pediatric earthquake-related injuries, treatment performed, length of stay, and complications; and (2) identify starting points to define standards of care. PubMed database was researched for papers (1999-2014 period) in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Inclusion criteria were: English, French, Spanish, or Italian language and data reported about orthopedic lesions in children (≤18 years old). Reviews, letters, commentaries, editorials, and single case reports were excluded. Two independent reviewers selected articles after abstract and full-text reading. Traumatic injuries caused child hospital admissions ranging from 46.9% to 100.0%; 16% to 53% suffered fractures. Lower limbs mostly were involved. Soft-tissue injuries affected 55% of patients. Debridement and external fixation (EF) were the most frequent surgical treatments. Amputation rates varied from 5% to 11%. This study revealed that field hospitals should be prepared to: (1) treat mainly lower extremities fractures in children; and (2) use especially EF techniques. The presence of orthopedic surgeons familiar with pediatric traumatology should be considered.
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