2023 Kahramanmaraş Depremleri Sonrası Protez Uygulanması Amacıyla Başvuran Ampute Çocukların Değerlendirilmesi

Year 2024, Volume: 46 Issue: 2, 209 - 216, 18.03.2024

Aylin Sarıyıldız Sıla Ölmez Engizek Sibel Başaran

https://doi.org/10.20515/otd.1407971

Abstract

Ülkemiz tarihindeki en yıkıcı doğal afet olan 2023 Kahramanmaraş depremleri en savunmasız yaş grubunu oluşturan çocuklarda çeşitli travmatik yaralanmalara neden olmuştur. Kalıcı ve uzun dönem etkileri düşünüldüğünde amputasyonlar oldukça önemlidir. Ancak literatürde bu konudaki veriler kısıtlıdır. Bu çalışmada deprem ilişkili ampute çocukların sosyodemografik ve klinik verileri ile protez reçeteleme süreçleri değerlendirilmiştir. Depremle ilişkili uzuv kaybı olan 18 yaş ve altı çocuklar dahil edilmiştir. Hastaların sosyodemografik verileri, birinci derece yakın kayıpları, eşlik eden yaralanmaları, amputasyon ve protezle ilişkili verileri kaydedilmiştir. 86 ampute çocuğun ortanca yaşları 12,0 (min-maks=1-18) idi. Çocukların %87,2’sinde birinci derece yakın kaybı mevcuttu. %53,5’i depremi yaşadıkları yerden farklı bir ilde yaşamaya başlamıştı. Yumuşak doku defekti (n=77), periferik sinir hasarı (n=17), ezilme yaralanması (n=11) eşlik eden en sık yaralanmalardı. Toplam 103 amputasyonun %68,9’u alt ekstremitedeydi. En sık görülen amputasyon seviyeleri sırasıyla transtibial amputasyon (%27,2), transfemoral amputasyon (%24,3), transhumeral amputasyon (%15,5) ve diz dezartikülasyonu (%6,8) idi. Amputasyon sonrası protez uygulanana kadar geçen süre 159,71±46,8 gündü. Toplam 103 ampute uzuv için 81 protez (54 alt ekstremite, 27 üst ekstremite) reçete edildi. Depremle ilişkili amputasyonlar ağır fiziksel ve psikososyal sonuçlara neden olmaktadır. Bu etkileri en aza indirebilmek için ampute çocukların en kısa sürede multidisipliner ekip tarafından çok yönlü bakış açısıyla değerlendirilmesi büyük önem taşımaktadır. Sonuçlarımız gelecekte yaşanacak olası afetlere yönelik hazırlık, müdahale ve iyileştirme politikalarının geliştirilmesine rehberlik edecektir.

Keywords

Deprem, amputasyon, çocuk, protez

Evaluation of Pediatric Amputees Admitted for Prosthesis Application After the 2023 Kahramanmaraş Earthquakes

Abstract

The 2023 Kahramanmaraş earthquakes, most devastating natural disaster in our history, caused various traumatic injuries in children, who constitute the most vulnerable age group. Given their permanent and long-term effects, amputations are of great importance. However, the literature contains limited data on this subject. In the current study, sociodemographic and clinical data and prosthetic prescribing processes of children with earthquake-related limb loss were evaluated. Children aged 18 years and younger were included. Sociodemographic data, death of first-degree relatives, concomitant injuries, amputations, and prosthesis-related data were recorded. The median age of 86 amputee children was 12.0 (min-max=1-18) years. 87.2% of children had lost their first-degree relative(s). 53.5% had started living in a different province from where they experienced the earthquake. Soft tissue defects (n=77), peripheral nerve injuries (n=17),and crush injuries (n=11) were the most common concomitant injuries. Of the total 103 amputations, 68.9% were in the lower extremity. The most common amputation levels were transtibial amputation (27.2%), transfemoral amputation (24.3%), transhumeral amputation (15.5%), and knee disarticulation (6.8%), respectively. Time from amputation to prosthesis application was 159.71±46.8 days. 81 prostheses (54 lower limbs, 27 upper limbs) were prescribed for 103 amputations. Earthquake-related amputations cause severe physical and psychosocial consequences. It is of great importance that amputee children are evaluated by a multidisciplinary team at the earliest possible time to mitigate these effects. Our results will guide the establishment of policies regarding preparedness, intervention, and recovery for possible future disasters.

Keywords

Earthquake, amputation, child, prosthesis

References

• 1. Hussain E, Kalaycıoğlu S, Milliner CWD, Çakir Z. Preconditioning the 2023 Kahramanmaraş (Türkiye) earthquake disaster. Nat Rev Earth Environ 2023;4(5):287-9.
• 2. McQuerry J, Gammon L, Carpiaux A, Talwalkar V, Iwinski H, Walker J, Jacobs CA, Muchow R. Effect of Amputation Level on Quality of Life and Subjective Function in Children. J Pediatr Orthop 2019;39(7):e524-30.
• 3. Khan YS, Khan AW, Alabdulla M. The psychological impact of the Turkey-Syria earthquake on children: addressing the need for ongoing mental health support and global humanitarian response. Eur J Psychotraumatol 2023;14(2):2249788.
• 4. Wu J, He X, Li Y, Shi P, Ye T, Li N. How earthquake-induced direct economic losses change with earthquake magnitude, asset value, residential building structural type and physical environment: an elasticity perspective. J Environ Manage 2019;231:321–8.
• 5. Andrades M, García FE, Kilmer RP. Post-traumatic stress symptoms and post-traumatic growth in children and adolescents 12 months and 24 months after the earthquake and tsunamis in Chile in 2010: A longitudinal study. Int J Psychol 2021;56(1):48-55.
• 6. Dube A, Moffatt M, Davison C, Bartels S. Health Outcomes for Children in Haiti Since the 2010 Earthquake: A Systematic Review. Prehosp Disaster Med 2018;33(1):77-88.
• 7. Morelli I, Sabbadini MG, Bortolin M. Orthopedic Injuries and Their Treatment in Children During Earthquakes: A Systematic Review. Prehosp Disaster Med 2015;30(5):478-85.
• 8. Zhao J, Shi Y, Hu Z, Li H. Sichuan earthquake and emergency relief care for children: report from the firstly arrived pediatricians in the epicenter zone. Pediatr Emerg Care 2011;27(1):17-20.
• 9. Kundakci B, Mirioglu A, Tekin M, Bagir M, Bicer OS, Arslan YK, Ozkan C, Ozbarlas HS. 6 February 2023, orthopedic experience in Kahramanmaraş earthquake and surgical decision in patients with crush syndrome. J Orthop Surg Res 2023;18(1):537.
• 10. Louer CR Jr, Scott-Wyard P, Hernandez R, Vergun AD. Principles of Amputation Surgery, Prosthetics, and Rehabilitation in Children. J Am Acad Orthop Surg 2021;29(14):e702-13.
• 11. Awais 2012- Awais SM, Dar UZ, Saeed A. Amputations of limbs during the 2005 earthquake in Pakistan: a firsthand experience of the author. Int Orthop 2012;36(11):2323-6.
• 12. Bar-On E, Lebel E, Blumberg N, Sagi R, Kreiss Y; Israel Defense Forces Medical Corps, Petah Tikva, Israel. Pediatric Orthopedic Injuries Following an Earthquake: Experience in an Acute-Phase Field Hospital. J Trauma Nurs 2015;22(4):223-8.
• 13. Sarisözen B, Durak K. Extremity injuries in children resulting from the 1999 Marmara earthquake: an epidemiologic study. J Pediatr Orthop B 2003;12(4):288-91.
• 14. Yang ZQ, Zhang QM. Rehabilitation care for children after trauma in the earthquake disaster. Zhongguo Dang Dai Er Ke Za Zhi 2013;15(6):431-4.
• 15. Keszler MS, Heckman JT, Kaufman GE, Morgenroth DC. Advances in Prosthetics and Rehabilitation of Individuals with Limb Loss. Phys Med Rehabil Clin N Am 2019;30(2):423-37.
• 16. Iezzoni LI, Ronan LJ. Disability legacy of the Haitian earthquake. Ann Intern Med 2010;152(12):812-4.
• 17. Randolph MG, Elbaum L, Wen PS, Brunt D, Larsen J, Kulwicki A, De la Rosa M. Functional and psychosocial status of Haitians who became users of lower extremity prostheses as a result of the 2010 earthquake. J Prosthet Orthot 2014;26(4):177-82.
• 18. Godwin Y, Ahmed A, Shaat HY. A review of the first wave of lower limb amputees from the Great March of Return in Gaza: Taking stock and preparing for the task ahead. Injury 2022;53(7):2541-9.
• 19. Özdemir G, Karlıdağ T, Bingöl O, Sarıkaya B, Çağlar C, Bozkurt İ, Akkurt MO, Mantı N, Gencer B, Biçici V, Çepni Ş, Köse CC, Doğan Ö, İnci F, Ceyhan E, Yavuz İA, Gülçek M, Alkan H, Turan S, Kılıçaslan K, Doğan M, Özkurt B, Tecimel O, Solak AŞ, Uluyardımcı E, Özaslan Hİ, Bozer M, Güven Ş, Erdem E, Ülgen NK, Aydın T, Güllerci AM, Keskin ÖH. Systematic triage and treatment of earthquake victims: Our experience in a tertiary hospital after the 2023 Kahramanmaras earthquake. Jt Dis Relat Surg 2023;34(2):480-7.
• 20. Yılmaz S, Karakayali O, Yilmaz S, Çetin M, Eroglu SE, Dikme O, Özhasenekler A, Orak M, Yavaşi Ö, Karbek Akarca F, Günalp Eneyli M, Erbil B, Akoğlu H. Emergency Medicine Association of Turkey Disaster Committee Summary of Field Observations of February 6th Kahramanmaraş Earthquakes. Prehosp Disaster Med 2023;38(3):415-8.
• 21. Sarı H, Özel M, Akkoç MF, Şen A. First-Week Analysis after the Turkey Earthquakes: Demographic and Clinical Outcomes of Victims. Prehosp Disaster Med 2023;38(3):294-300.
• 22. Uluöz M, Gökmen MY. The 2023 Turkey Earthquake: Management of 627 Pediatric Musculoskeletal Injuries in the First Month. Children (Basel) 2023;10(11):1733.
• 23. Bingol O, Karlidag T, Keskin OH, Kilic E, Sarikaya B, Ozdemir G. Preventing extremity amputations after earthquakes: a quantitative analysis of fasciotomy and extrication time. Eur J Trauma Emerg Surg 2023;49(6):2515-20.
• 24. Xiao Y, Liu D, Liu K, Jiang X. Post-traumatic stress disorder and its risk factors in bereaved Tibetan adolescents 3 years after the 2010 Yushu earthquake, a cross-sectional study in China. Arch Psychiatr Nurs 2019;33(2):149-54.
• 25. Zhou X, Wu X. Shared or unique trajectories of PTSD and depression in children over time since an earthquake. Clin Child Psychol Psychiatry 2021;26(4):1003-17.
• 26. Dyregrov A, Yule W, Olff M. Children and natural disasters. Eur J Psychotraumatol 2018;9(Suppl 2):1500823.