Firearm Injuries on Orthopedic Services in Tripoli, Libya: Resource Utilization, Costs, and Implications for Health Policy

Orthopaedic burden of firearm injuries in Tripoli Abstract Purpose: Gunshot injuries (GSIs) impose a growing burden on healthcare systems in Libya, particularly orthopaedic services. This study quantifies resource use, direct costs, and injury/demographic profiles of orthopaedic GSI patients in Tripoli. Methods: A retrospective descriptive study of 470 patients admitted to orthopaedic departments of three tertiary hospitals in Tripoli between 1 June 2021 and 1 March 2022 with firearm related orthopaedic injuries. Extracted data included demographics, fracture types, surgical interventions (procedures, implants), length of stay, and direct hospital costs (in Libyan Dinars, LD). Descriptive statistics were used. Results: Mean patient age was 28 years (range 13–68); male:female ratio ≈ 8:1. Total fractures numbered 257, predominantly in lower limbs. Surgical intervention was performed in 182 patients (38.7 %), with 196 procedures and 199 implants (mostly external fixators, followed by internal fixation devices). Mean hospital stay was 18.5 days (range 2–35). Mean direct cost per patient was ~ 22,000 LD; extreme cases reached ~ 29,000 LD. Among orthopaedic trauma, GSIs represented the second highest resource burden after road traffic accidents. Conclusions: Gunshot injuries exert substantial strain on orthopaedic services in Tripoli, via prolonged hospitalisation and extensive surgical and implant use. Policymakers should prioritise trauma prevention, dedicated trauma funding, capacity building in orthopaedic trauma care, and hospital system improvements to mitigate this burden.