title: Orthopedic trauma surgery and hospital cost analysis in refugees; the effect of the Syrian civil War.
abstract: The aim of this study was to evaluate the musculoskeletal injury types, injury mechanisms, surgical techniques and treatment costs of Syrian refugees.
  
  
  
  Totally 158 patients (67 female, 91 male) treated in our clinic in 34 months period between January 2012 and October 2014 were included in the study. The mean age of the patients was 39.3 years (range: 18-82 years). The patients were evaluated for age, gender, mechanism of injury, location and type of fracture, presence of accompanying injuries, injury severity score, surgical technique, complications, mortality/morbidity and treatment cost.
  
  
  
  The injuries were more frequently reported in lower extremities, upper extremities and axial skeleton, respectively. Blunt trauma was significantly higher in upper extremity injuries compared with the other types of injuries (p = 0.001). Fractures were most commonly reported in foot/ankle region and in males, hand/wrist fractures were significantly higher than that of the females. Plate fixation of upper extremity fractures and intramedullary nailing in lower extremity fractures were the most commonly preferred treatment modalities. The mean hospitalization period of patients was 5.6 days and the mean treatment cost was 3844 Turkish Liras (TL).
  
  
  
  In this study, it was shown that there was a statistically significant increase in the cost of health expenses in patients with fall from heights or gunshot wound, with fractures in axial skeleton or with the ISS score between 16 and 66. The cost rise was associated with worse prognosis, complications, intensive care treatments and prolonged hospitalization periods.
authors.affiliation: Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey. altug.duramaz@yahoo.com.
authors.forename: Altuğ
authors.initials: A
authors.lastname: Duramaz
authors.affiliation: Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
authors.forename: Mustafa Gökhan
authors.initials: MG
authors.lastname: Bilgili
authors.affiliation: Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
authors.forename: Berhan
authors.initials: B
authors.lastname: Bayram
authors.affiliation: Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
authors.forename: Nezih
authors.initials: N
authors.lastname: Ziroğlu
authors.affiliation: Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
authors.forename: Alkan
authors.initials: A
authors.lastname: Bayrak
authors.affiliation: Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
authors.forename: Mustafa Cevdet
authors.initials: MC
authors.lastname: Avkan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000068337:Armed Conflicts / Q000706:statistics & numerical data*; D005260:Female; D050723:Fractures, Bone / Q000191:economics / Q000601:surgery*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009985:Orthopedics / Q000191:economics / Q000706:statistics & numerical data*; D012036:Refugees / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013593:Syria / Q000208:ethnology; D014421:Turkey / Q000453:epidemiology; D014947:Wounds and Injuries / Q000191:economics / Q000601:surgery*; D055815:Young Adult
keywords: Cost analysis; Orthopedic surgery; Syrian refugees; War trauma