Abstract

Introduction: On September 17, 2024, a coordinated detonation of hundreds of pagers across multiple regions in Lebanon caused a devastating mass-casualty incident with high concentration of complex hand injuries. This study aims to describe the musculoskeletal injuries, outline the acute response management protocol in a resource-challenged setting and identify lessons to improve future disaster preparedness.
Methods: This retrospective case-series was conducted including all patients admitted to our hospital suffering from musculoskeletal injuries directly related to the incident. Demographic characteristics, injury patterns, operative management, missed diagnoses, and need for secondary intervention were recorded. Associated injuries with other systems were also analyzed.
Results: A total of 45 patients [43 males] were included. Age ranged from 4 to 59 years (mean of 34 +/- 9.7 years). Hand trauma was the most frequent injury, affecting 42 out of 45 patients, with 25 cases involving bilateral damage, Totaling 67 injured hands. Additional musculoskeletal injuries included 10 lower-limb deep lacerations, 2 iliac bones fractures and 3 forearm penetrating wounds. Concomitant injuries were common, particularly ocular trauma in 38 patients. Initial surgery focused on debridement, fracture stabilization, foreign body removal and soft-tissue coverage. K wires were applied in 10 hands. Postoperative radiographs identified 15 missed injuries, of which six required revision surgery.
Conclusion: This incident was a significant and unique challenge for healthcare workers, particularly in the field of orthopedic surgery. Rapid triage, early debridement, prioritization of thumb and digit preservation and parallel multi-team workflow proved effective in managing the surge of patients. Lessons learned from such events highlight the need for disaster protocols in order to improve preparedness and optimize patient care in future mass-casualty encounters.

Keywords: Mass-casualty incident; Mangled hands; Digit amputation; Polytrauma