Date of Award

1-1-2024

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Brianna R. Fram

Abstract

Introduction:This thesis critically examines the epidemiological trends and clinical outcomes associated with ballistic and explosive orthopedic trauma, focusing exclusively on data coming from low- and middle-income countries (LMICs). Given the rising prevalence of civilian casualties in contemporary conflict zones and incidents of urban gun violence, there is an amplified need to bolster our understanding of these injuries. This is particularly important in LMIC civilian settings where a majority of this trauma is occurring but where the current literature is extremely lacking. This research aims to contribute significantly to the global medical community's capacity to provide informed, LMIC relevant evidence-based care to serve the growing need in these regions of the world. Methods: We conducted a retrospective analysis using the Surgical Implant Generation Network (SIGN) Fracture Care database, which includes data from over 100,000 cases of surgically treated orthopedic fractures coming from 425 partner sites in 57 LMIC countries. The SIGN implants primarily center around the use of an intramedullary fixation devices but do also contain plates and screws for fixation. Injury cause data was collected starting in 2016, thus all cases with a documented injury cause between January 1st, 2016, and January 30th, 2023, were included in our study. The study's scope covered demographic data, injury causation, therapeutic interventions, and follow-up results, with a particular emphasis on infection rates (minimum follow-up 30 days), instances of nonunion (minimum follow-up 180 days), and the capability for painless weight bearing (minimum follow-up 90 days) as a measure of functional recovery. Data organization and analytical procedures were conducted using R, incorporating both univariate and multivariable logistic regression to distill associations and outcomes. Multivariable analysis was limited to the infection outcome only due to higher rates of loss to follow-up with later follow-up time points. Complete case analysis was used for the multivariable analysis. Results: The study included 117,729 cases with a documented injury cause between 2016 and 2023. Of these, we identified 5,256 cases of ballistic fractures and 985 explosive-related fractures. The average time to surgery for these injuries was significantly longer than for other trauma types, with 40% of explosive and 30% of ballistic injury cases waiting over 30 days for surgery (p =

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