Hostname: page-component-848d4c4894-4rdrl Total loading time: 0 Render date: 2024-06-22T00:20:22.370Z Has data issue: false hasContentIssue false

Orthopedic Injuries and Their Treatment in Children During Earthquakes: A Systematic Review

Published online by Cambridge University Press:  19 August 2015

Ilaria Morelli*
Orthopaedics and Traumatology Department, Vita-Salute San Raffaele University - San Raffaele Hospital, Milan, Italy
Maria Grazia Sabbadini
Internal Medicine - Clinical Immunology, Rheumatology and Allergy Section, Vita-Salute San Raffaele University - San Raffaele Hospital, Milan, Italy
Michelangelo Bortolin
Orthopaedics and Traumatology Department, Vita-Salute San Raffaele University - San Raffaele Hospital, Milan, Italy Emergency Medical System, Torino, Italy
Correspondence: Ilaria Morelli, MD IRCSS San Raffaele via Olgettina 60 20132, Milan, Italy E-mail:


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.

MorelliI, SabbadiniMG, BortolinM. Orthopedic Injuries and Their Treatment in Children During Earthquakes: A Systematic Review. Prehosp Disaster Med. 2015;30(5):478–485.

Comprehensive Reviews
© World Association for Disaster and Emergency Medicine 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


1. Gausche-Hill, M. Pediatric disaster preparedness: are we really prepared? J Trauma. 2009;67(2 Suppl):S73-S76.Google Scholar
2. Rodríguez-Merchán, EC. Pediatric fractures of the forearm. Clin Orthop Relat Res. 2005;432:65-72.Google Scholar
3. de Billy, B, Gindraux, F, Langlais, J. Osteotomy and fracture fixation in children and teenagers. Orthop Traumatol Surg Res. 2014;100(1 Suppl):S139-S148.Google Scholar
4. Moher, D, Liberati, A, Tetzlaff, J, Altman, DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.Google Scholar
5. Bar-On, E, Lebel, E, Blumberg, N, Sagi, R, Kreiss, Y, Israel Defense Forces Medical Corps. Pediatric orthopedic injuries following an earthquake: experience in an acute-phase field hospital. J Trauma Acute Care Surg. 2013;74(2):617-621.Google Scholar
6. Gamulin, A, Armenter-Duran, J, Assal, M, Hagon, O, Dayer, R. Conditions found among pediatric survivors during the early response to natural disaster: a prospective case study. J Pediatr Orthop. 2012;32(4):327-333.Google Scholar
7. Sarizösen, B, Durak, K. Extremity injuries in children resulting from the 1999 Marmara Earthquake: an epidemiologic study. J Pediatr Orthop B. 2003;12(4):288-291.Google Scholar
8. Xiang, B, Cheng, W, Liu, J, Huang, L, Li, Y, Liu, L. Triage of pediatric injuries after the 2008 Wen-Chuan Earthquake in China. J Pediatr Surg. 2009;44(12):2273-2277.Google Scholar
9. Li, T, Jiang, X, Chen, H, Yang, Z, Wang, X, Wang, M. Orthopaedic injury analysis in the 2010 Yushu, China Earthquake. Injury. 2012;43(6):886-890.Google Scholar
10. Sabzehchian, M, Abolghasemi, H, Radfar, MH, Jonaidi-Jafari, N, Ghasemzadeh, H, Burkle, FM Jr. Pediatric trauma at tertiary-level hospitals in the aftermath of the Bam, Iran Earthquake. Prehosp Disaster Med. 2006;21(5):336-339.Google Scholar
11. Farfel, A, Assa, A, Amir, I, et al. Haiti Earthquake 2010: a field hospital pediatric perspective. Eur J Pediatr. 2011;170(4):519-525.Google Scholar
12. Walk, RM, Donahue, TF, Sharpe, RP, Safford, SD. Three phases of disaster relief in Haiti—pediatric surgical care on board the United States Naval Ship Comfort. J Pediatr Surg. 2011;46(10):1978-1984.Google Scholar
13. Jain, V, Noponen, R, Smith, BM. Pediatric surgical emergencies in the setting of a natural disaster: experiences from the 2001 earthquake in Gujarat, India. J Pediatr Surg. 2003;38(5):663-667.Google Scholar
14. Zhao, J, Shi, Y, Hu, Z, Li, H. Sichuan Earthquake and emergency relief care for children report from the first pediatricians to arrive in the epicenter zone. Pediatr Emerg Care. 2011;27(1):17-20.Google Scholar
15. Rigal, S, Pons, F. Triage of mass casualties in war conditions: realities and lessons learned. Int Orthop. 2013;37(8):1433-1438.Google Scholar
16. Wilkins, KE, Aroojis, AJ. “Incidence of fractures in children.” In: Beaty JH, Kasser JR, (eds). Rockwood and Wilkins’ Fractures in Children. Philadelphia, Pennsylvania USA: Lippincott Williams & Wilkins; 2006.Google Scholar
17. Kim, PH, Leopold, SS. Gustilo-Anderson classification. Clin Orthop Relat Res. 2012;470(11):3270-3274.Google Scholar
18. Cross, WW 3rd, Swiontkowski, MF. Treatment principles in the management of open fractures. Indian J Orthop. 2008;42(4):377-386.Google Scholar
19. Bertol, MJ, Van den Bergh, R, Trelles Centurion, M, et al. Saving life and limb: limb salvage using external fixation, a multi-centre review of orthopaedic surgical activities in Médecins Sans Frontières. Int Orthop. 2014;38(8):1555-1561.Google Scholar
20. Taeger, G, Ruchholtz, S, Waydhas, C, Lewan, U, Schmidt, B, Nast-Kolb, D. Damage control orthopedics in patients with multiple injuries is effective, time saving, and safe. J Trauma. 2005;59(2):409-416.Google Scholar
21. Knowlton, LM, Gosney, JE, Chackungal, S, et al. Consensus statements regarding the multidisciplinary care of limb amputation patients in disasters or humanitarian emergencies: report of the 2011 Humanitarian Action Summit Surgical Working Group on amputations following disasters or conflict. Prehosp Disaster Med. 2011;26(6):438-448.Google Scholar
22. Nickerson, JW, Chackungal, S, Knowlton, L, McQueen, K, Burkle, FM. Surgical care during humanitarian crises: a systematic review of published surgical caseload data from foreign medical teams. Prehosp Disaster Med. 2012;27(2):184-189.Google Scholar
23. Chu, KM, Ford, N, Trelles, M. Operative mortality in resource-limited settings: the experience of Medecins Sans Frontieres in 13 countries. Arch Surg. 2010;145(8):721-725.Google Scholar