{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T22:44:30Z","timestamp":1793573070543,"version":"4.5.0"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T00:00:00Z","timestamp":1755043200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T00:00:00Z","timestamp":1755043200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100031807","name":"M\u00e9decins Sans Fronti\u00e8res France","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100031807","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["International Orthopaedics (SICOT)"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>The Aden Trauma Centre in Yemen, supported by M\u00e9decins Sans Fronti\u00e8res (MSF), introduced internal fixation (IF) procedures to address the high burden of fractures as a result of road traffic accidents and conflict-related injuries. This study aimed to describe the clinical characteristics of patients undergoing IF, evaluate their complication and healing outcomes, and explore factors influencing postoperative results.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A retrospective cohort design was employed, including all patients who underwent internal fixation\u2014using SIGN nails or plates\/screws\u2014between January and December 2022. Demographic information, fracture characteristics, surgical techniques, and postoperative outcomes were analyzed. Cox proportional hazards models were used to identify key predictors of complications and bone healing.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>A total of 177 patients (208 fractures) were included. The overall complication rate was 14.4%. Open fractures and comorbidities were significant predictors of complications, while type of implant (SIGN nail vs. plate\/screws) did not affect complication risk. Around three-quarters of fractures achieved radiographic healing at a median of five to six months. Infection and other complications emerged as major risk factors for delayed or impaired union. About a quarter of patients defaulted from care, potentially underestimating late complications and nonunion rates.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Findings indicate that IF is feasible and effective in this high-need, low-resource context, demonstrating complication rates in line with global estimates. Open fractures, comorbidities, and limited follow-up infrastructure remain the main challenges to optimizing outcomes in such contexts. <\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00264-025-06616-y","type":"journal-article","created":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T06:20:14Z","timestamp":1755066014000},"page":"2403-2413","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Clinical outcomes of internal fixation orthopaedic surgery in humanitarian settings: a retrospective cohort study at the M\u00e9decins Sans Fronti\u00e8res (MSF) trauma centre in Aden, Yemen"],"prefix":"10.1007","volume":"49","author":[{"given":"Rami","family":"Malaeb","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taha","family":"Hussain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fares","family":"Ayyash","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulsalam","family":"Abdullah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hameed S.","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled","family":"Abdulrahman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adel","family":"Al Haj","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hesham","family":"Bin Shahna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evgenia","family":"Zelikova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Hassanin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Poulet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Herard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rasheed","family":"Fakhri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,13]]},"reference":[{"key":"6616_CR1","unstructured":"World Health Organization (2024) Injuries and violence. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/injuries-and-violence. Accessed 5 Dec 2024"},{"key":"6616_CR2","doi-asserted-by":"publisher","first-page":"e281","DOI":"10.1055\/s-0041-1732351","volume":"7","author":"D Shanthakumar","year":"2021","unstructured":"Shanthakumar D, Payne A, Leitch T, Alfa-Wali M (2021) Trauma care in Low- and Middle-Income countries. Surg J (N Y) 7:e281\u2013e285. https:\/\/doi.org\/10.1055\/s-0041-1732351","journal-title":"Surg J (N Y)"},{"key":"6616_CR3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00268-014-2685-x","volume":"39","author":"H Higashi","year":"2015","unstructured":"Higashi H, Barendregt JJ, Kassebaum NJ, Weiser TG, Bickler SW, Vos T (2015) Burden of injuries avertable by a basic surgical package in low-and middle-income regions: A systematic analysis from the global burden of disease 2010 study. World J Surg 39:1\u20139. https:\/\/doi.org\/10.1007\/s00268-014-2685-x","journal-title":"World J Surg"},{"key":"6616_CR4","doi-asserted-by":"publisher","unstructured":"Roberts SE, Thorne K, Akbari A (2016) Epidemiology of fatalities and orthopaedic trauma in armed conflicts and natural disasters. Orthopaedic trauma in the austere environment. Springer International Publishing, pp 23\u201361. https:\/\/doi.org\/10.1007\/978-3-319-29122-2_3","DOI":"10.1007\/978-3-319-29122-2_3"},{"key":"6616_CR5","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1007\/s44250-023-00038-6","volume":"2","author":"AJ Nashwan","year":"2023","unstructured":"Nashwan AJ, Ahmed SH, Shaikh TG, Waseem S (2023) Impact of natural disasters on health disparities in low- to middle-income countries. Discov Health Syst 2:38. https:\/\/doi.org\/10.1007\/s44250-023-00038-6","journal-title":"Discov Health Syst"},{"key":"6616_CR6","unstructured":"M\u00e9decins Sans Fronti\u00e8res (2023) International Activity Report 2023. https:\/\/www.msf.org\/international-activity-report-2023"},{"key":"6616_CR7","doi-asserted-by":"publisher","first-page":"2675","DOI":"10.1007\/s00264-018-3864-4","volume":"42","author":"RE Koso","year":"2018","unstructured":"Koso RE, Terhoeve C, Steen RG, Zura R (2018) Healing, nonunion, and re-operation after internal fixation of diaphyseal and distal femoral fractures: a systematic review and meta-analysis. Int Orthop 42:2675\u20132683. https:\/\/doi.org\/10.1007\/s00264-018-3864-4","journal-title":"Int Orthop"},{"key":"6616_CR8","doi-asserted-by":"publisher","DOI":"10.1007\/s00068-023-02323-8","author":"OM Shodipo","year":"2023","unstructured":"Shodipo OM, Balogun MJ, Ramat AM, Ibrahim SS, Jatto HI, Ajiboye LO, Lawal MA, Lasebikan OA (2023) Monolateral external fixation versus internal fixation of Gustilo IIIB open tibial fractures: a multicenter comparative study. Eur J Trauma Emerg Surg. https:\/\/doi.org\/10.1007\/s00068-023-02323-8","journal-title":"Eur J Trauma Emerg Surg"},{"key":"6616_CR9","doi-asserted-by":"publisher","first-page":"1901","DOI":"10.1007\/s00264-015-2781-z","volume":"39","author":"O Alvarado","year":"2015","unstructured":"Alvarado O, Trelles M, Tayler-Smith K et al (2015) Orthopaedic surgery in natural disaster and conflict settings: how can quality care be ensured? Int Orthop 39:1901\u20131908. https:\/\/doi.org\/10.1007\/s00264-015-2781-z","journal-title":"Int Orthop"},{"key":"6616_CR10","doi-asserted-by":"publisher","first-page":"848","DOI":"10.1186\/s12891-021-04688-6","volume":"22","author":"B Prediger","year":"2021","unstructured":"Prediger B, Tjardes T, Probst C, Heu-Parvaresch A, Glatt A, dos Anjos DR, Bouillon B, Mathes T (2021) Factors predicting failure of internal fixations of fractures of the lower limbs: a prospective cohort study. BMC Musculoskelet Disord 22:848. https:\/\/doi.org\/10.1186\/s12891-021-04688-6","journal-title":"BMC Musculoskelet Disord"},{"key":"6616_CR11","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1089\/sur.2017.273","volume":"19","author":"TJ McQuillan","year":"2018","unstructured":"McQuillan TJ, Cai LZ, Corcoran-Schwartz I, Weiser TG, Forrester JD (2018) Surgical site infections after open reduction internal fixation for trauma in low and middle human development index countries: A systematic review. Surg Infect (Larchmt) 19:254\u2013263. https:\/\/doi.org\/10.1089\/sur.2017.273","journal-title":"Surg Infect (Larchmt)"},{"key":"6616_CR12","doi-asserted-by":"publisher","first-page":"e68","DOI":"10.1097\/GH9.0000000000000068","volume":"5","author":"J Costa","year":"2022","unstructured":"Costa J, Briskin E, Trelles M, Dominguez L, Nyaruhirira I, Shinwari E, Niyonzima F, Adel A, Haberisoni J-B, Ali E (2022) The burden of road traffic accidents in trauma in low-resource settings: a retrospective cohort analysis of patient admissions to two m\u00e9decins Sans fronti\u00e8res trauma facilities. Int J Surg Glob Health 5:e68. https:\/\/doi.org\/10.1097\/GH9.0000000000000068","journal-title":"Int J Surg Glob Health"},{"key":"6616_CR13","unstructured":"World Health Organization (2018) Global guidelines for the prevention of surgical site infection. https:\/\/www.who.int\/publications\/i\/item\/9789241550475"},{"key":"6616_CR14","doi-asserted-by":"publisher","first-page":"737","DOI":"10.3109\/17453674.2011.636680","volume":"82","author":"S Young","year":"2011","unstructured":"Young S, Lie SA, Hallan G, Zirkle LG, Enges\u00e6ter LB, Havelin LI (2011) Low infection rates after 34,361 intramedullary nail operations in 55 low- and middle-income countries: validation of the surgical implant generation network (SIGN) online surgical database. Acta Orthop 82:737\u2013743. https:\/\/doi.org\/10.3109\/17453674.2011.636680","journal-title":"Acta Orthop"},{"key":"6616_CR15","doi-asserted-by":"publisher","unstructured":"Hutaif M, Issa MAN, Humaid H (Feb. 2024) Assessing the effectiveness of intramedullary nailing for tibial shaft fractures in a low-income setting: a prospective study in Yemen. Eur J Orthop Surg Traumatol 34(2):995\u20131002. https:\/\/doi.org\/10.1007\/s00590-023-03753-1","DOI":"10.1007\/s00590-023-03753-1"},{"key":"6616_CR16","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1007\/s00268-012-1817-4","volume":"37","author":"S Young","year":"2013","unstructured":"Young S, Lie SA, Hallan G, Zirkle LG, Enges\u00e6ter LB, Havelin LI (2013) Risk factors for infection after 46,113 intramedullary nail operations in low- and middle-income countries. World J Surg 37:349\u2013355. https:\/\/doi.org\/10.1007\/s00268-012-1817-4","journal-title":"World J Surg"},{"key":"6616_CR17","doi-asserted-by":"publisher","DOI":"10.1007\/s12178-024-09917-8","author":"EL DeMaio","year":"2024","unstructured":"DeMaio EL, Marra G, Suleiman LI, Tjong VK (2024) Global health inequities in orthopaedic care: perspectives beyond the US. Curr Rev Musculoskelet Med. https:\/\/doi.org\/10.1007\/s12178-024-09917-8","journal-title":"Curr Rev Musculoskelet Med"},{"key":"6616_CR18","doi-asserted-by":"publisher","first-page":"145","DOI":"10.11604\/pamj.2018.29.145.12974","volume":"29","author":"E Alfalahi","year":"2018","unstructured":"Alfalahi E, Assabri A, Khader Y (2018) Pattern of road traffic injuries in yemen: a hospital-based study. Pan Afr Med J 29:145. https:\/\/doi.org\/10.11604\/pamj.2018.29.145.12974","journal-title":"Pan Afr Med J"},{"key":"6616_CR19","doi-asserted-by":"publisher","DOI":"10.11604\/pamj.2018.29.145.12974","author":"E Alfalahi","year":"2018","unstructured":"Alfalahi E, Assabri A, Khader Y (2018) Pattern of road traffic injuries in yemen: A hospital-based study. Pan Afr Med J. https:\/\/doi.org\/10.11604\/pamj.2018.29.145.12974","journal-title":"Pan Afr Med J"},{"key":"6616_CR20","doi-asserted-by":"publisher","first-page":"1451","DOI":"10.1007\/s00264-025-06506-3","volume":"49","author":"Z Jodoin","year":"2025","unstructured":"Jodoin Z, Sheikh D, Atkinson C, Vo LU, Moreira A, Brady C, Zelle B (2025) Paediatric ballistic fracture patients: who has poor follow-up and why? Int Orthop 49:1451\u20131460. https:\/\/doi.org\/10.1007\/s00264-025-06506-3","journal-title":"Int Orthop"},{"key":"6616_CR21","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1007\/s00264-024-06402-2","volume":"49","author":"X Hu","year":"2025","unstructured":"Hu X, Wang P, Li C, Liu L, Wang X, Jin L, Zhao K, Wang L, Hou Z (2025) Development and validation of the nomogram of high fascial compartment pressure with Pilon fracture. Int Orthop 49:503\u2013513. https:\/\/doi.org\/10.1007\/s00264-024-06402-2","journal-title":"Int Orthop"}],"container-title":["International Orthopaedics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00264-025-06616-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00264-025-06616-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00264-025-06616-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T07:32:19Z","timestamp":1759303939000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00264-025-06616-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,13]]},"references-count":21,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["6616"],"URL":"https:\/\/doi.org\/10.1007\/s00264-025-06616-y","relation":{},"ISSN":["0341-2695","1432-5195"],"issn-type":[{"value":"0341-2695","type":"print"},{"value":"1432-5195","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,13]]},"assertion":[{"value":"14 May 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 July 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 August 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}