2024 international trauma care forum guest nation symposium: gunshot injuries

The Orthopaedic Trauma Association (OTA/AO) 2024 International Trauma Care Forum held in Montreal focused on the management of gunshot-related extremity trauma in both conventional and irregular warfare. Key presentations addressed the full-scale Russo-Ukrainian war and Colombia's enduring internal conflict, emphasizing the disproportionate burden of complex civilian injuries. In Ukraine, since the 2022 invasion, high-velocity ballistic and explosive trauma has resulted in injuries with extensive skeletal and soft tissue damage, often necessitating staged surgical debridement, external fixation, limb reconstruction, or amputation. Innovative techniques, including 3D-printed implants and regional or free flap coverage, have been incorporated into multidisciplinary protocols, despite significant limitations in subspecialty access and surgical resources. Conversely, Colombia's conflict-ongoing for over 7 decades-has resulted in over 2 million registered victims who have sustained physical injuries caused by bullets, explosions, or other war-related trauma, including both combatants and civilians. Urban areas primarily see low-energy gunshot wounds, whereas rural zones are affected by higher-energy injuries caused by improvised landmines and other unconventional weapons. Treatment is complicated by delayed evacuation, lack of trauma system infrastructure, and biologically contaminated injuries leading to high infection rates. The forum highlighted the importance of adaptable, evidence-based protocols, antimicrobial stewardship, and long-term rehabilitation strategies. The consensus of the expert panel was that the persistent burden of extremity trauma in conflict settings demands coordinated global trauma systems and equitable access to limb preservation and reconstructive care.