Trauma care in conflict areas: A retrospective descriptive analysis of orthopedic injuries and management during recent conflict events

The recent escalation of conflict in Gaza has resulted in a substantial burden of trauma-related injuries, particularly orthopedic trauma, with a total of 362 patients included in this study. This study presents a retrospective descriptive analysis of epidemiology, injury patterns, and clinical management of encountered orthopedic trauma cases during the conflict. This study aimed to characterize the mechanisms, patterns, and outcomes of orthopedic injuries sustained during the ongoing war in Gaza, with the goal of informing surgical response, resource allocation, and emergency preparedness in conflict settings. Data were retrospectively collected from the paper medical records of 362 patients with both direct conflict-related trauma and indirect conflict-affected orthopedic conditions, treated at the Jordanian Military Field Hospital - Southern Gaza (Khan Younis), between June 22 and October 2, 2024. Variables included demographic data, injury mechanisms, anatomical and injury types, surgical interventions, anesthesia modalities, perioperative care, and outcomes. Descriptive statistics were used to report frequencies, percentages, and means. The study included predominantly male patients (78.5%) with a mean age of 29.6 years. Blast injuries (48.3%) and gunshot wounds (31.2%) were the leading causes of trauma. The most common injuries were femur fractures (36.5%) and acute open fractures (36.2%). Frequent procedures included open reduction and internal fixation (34.8%) and fixation device removal (29.0%). General anesthesia (32.3%) and spinal anesthesia (29.8%) were commonly used, and all patients received antibiotics (100.0%). Anticoagulants were administered to 47.5% of patients, and 92.3% received physiotherapy. Surgical complications were low (4.4%), with no recorded venous thromboembolism events or deaths within 9 months. Orthopedic trauma during the Gaza conflict was primarily characterized by blast and gunshot injuries, with femur fractures being most prevalent. These findings underscore the importance of targeted trauma care protocols and resource planning in conflict zones. Despite relatively low short-term complications, only 30.1% of patients regained independent ambulation at 3 months, underscoring a substantial early disability burden. The high incidence of complex injuries, incomplete follow-up, and cohort heterogeneity limit definitive conclusions, but the findings point to an urgent need for sustained international support for trauma care and rehabilitation systems in Gaza.