Authors
Dennis Bengtson, Rawand Haweizy, Khaldoon Bashaireh, Jonas Malmstedt, Andreas Älgå
Published in
PLOS global public health. Volume 6. Issue 7. Pages e0006627. Epub Jul 10, 2026.
Abstract
Most casualties of modern conflict are civilian, and extremity injuries are the most frequent injury type. However, prospectively epidemiological data on civilians with conflict-related extremity injuries remain scarce. We conducted a multi-site observational study of prospectively collected data from a randomized controlled trial on negative pressure wound therapy. The present study disregarded treatment modality and described adults with acute conflict-related extremity wounds not suitable for primary closure treated at two civilian trauma hospitals in Erbil, Iraq and Ar Ramtha, Jordan from 2015 until 2018. A total of 165 patients were included. Median age was 28 years (interquartile range [IQR] 21-34); 155 (94%) were male. Gunshot injuries were most common (100 [60%] patients), followed by blast injuries (63 [38%] patients). Fractures occurred in 93 (57%) patients, including 74 (45%) open fractures, of which 16 (22%) had wound infections, defined as purulent discharge. Concomitant injuries occurred in 43 (26%) patients, including fractures at a site other than the studied wound, penetrating abdominal injuries, and abdominal solid-organ or gastrointestinal injuries. Bleeding requiring transfusion affected 56 (35%) patients. Median hospital stay was 10 days (IQR 5-37), and one (1%) patient died. Patients treated in Ar Ramtha had more wounds, more concomitant injuries, more blast injuries, longer times to wound closure, and longer hospital stays than patients treated in Erbil. Fractures were common, including open fractures, and bleeding requiring transfusion was frequent. Infection among patients with open fractures was comparatively uncommon, although comparison with other settings is limited by differences in case mix and organization of care. Low in-hospital mortality likely reflects selection of patients who survived to reach hospital. By providing standardized prospective data on an underreported civilian conflict-injury population, this study may inform public health planning for surgical capacity, blood supply, wound care, and hospital resources in similar conflict-affected settings.
NCT02444598.
PMID:
42430328
Bibliographic data and abstract were imported from PubMed on 11 Jul 2026.
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