Epidemiology and treatment of musculoskeletal injuries in Mass Casualty Incident: a retrospective series from the pagers’ detonation in Lebanon

Purpose: On September 17, 2024, a coordinated detonation of pagers across multiple regions in Lebanon caused a devastating mass casualty event, resulting in over 2800 injuries and 9 fatalities. Most of the affected individuals suffered from severe hand and eye injuries. This study aims to describe the experience of the Orthopedic Department at anonymous and the treatment strategies that were adopted. Material and Methods: A retrospective review was conducted to analyze the musculoskeletal injuries sustained during this incident .Data collection included demographic data such as age and gender. Specific factors concerning musculoskeletal injuries such as hand dominance, unilateral or bilateral lesions, injury severity, surgical intervention, missed fractures and need for secondary surgeries were noted as well. Associated injuries, ocular penetrations, ear-drum perforations, brain contusions, intracranial hemorrhage, and facial fractures were also included. Results: 45 patients (43 males and 2 females) with musculoskeletal injuries were included in this study. Age ranged from 4 to 59 years with a mean of 34 +/- 9.7 years. The most common musculoskeletal trauma was a hand injury with 42 out of 45 patients, including 25 affected bilaterally totalizing 67 injured hands. Other musculoskeletal injuries included 10 deep wounds to the lower limbs, 2 iliac bones fractures and 3 forearm penetrating wounds, one of them causing an ulnar nerve palsy. Kirschner-wires were used in 10 hands initially and post operative X-Rays revealed 15 missed injuries, out of them, 6 underwent secondary surgeries. Conclusion: Mass causality incidents present a significant and unique challenge for healthcare workers particularly in the field of orthopedic surgery. Lessons learned from such events are critical to improve preparedness and optimize patient care in future encounters.