Changes in orthopaedic surgical procedures in post-war Afghanistan: A retrospective review of internal fixation procedures at Lashkar-Gah non-governmental organization hospital (2020 − 2023)

PURPOSE: Following 2 decades of conflict in Afghanistan, the withdrawal of international forces and the Taliban's return to power in August 2021 led to reduced war trauma cases. This study aims to analyze the changes in injury patterns and the trends in internal fixation procedures (IFPs) in a non-governmental organization (NGO) hospital in Afghanistan. METHODS: ). Group differences were assessed using the Mann-Whitney U test, and categorical variables were analyzed using the Chi-square test. RESULTS: A total of 2801 IFPs were analyzed. Non-war injuries (NWI) represented 2500 (89.3%), while war injuries (WI) represented 301 (10.7%). Post-conflict, there was a significant increase in IFPs, and a 275% increase in IFPs for NWI. We found 2085 closed fractures (74.4%), and 716 open fractures (25.6%). Among the NWI cases, 2036 (81.4%) were identified as closed fractures. In contrast, 252 (83.7%) WI cases involved open fracture (p < 0.001). The distal humerus was the most affected site in 736 (26.3%) cases. Kirschner wires were the most frequently used implant in 1561 (55.7%) procedures. The overall fracture-related infection rate was 2.3% (64 cases), significantly lower for NWI 2% (51 of 2500 cases) than WI 4.3% (13 of 301 cases), p = 0.010. CONCLUSIONS: These findings demonstrate that the end of the conflict brought a significant increase in orthopaedic IFPs facilitated by the reduced severity of trauma in post-conflict Afghanistan. This study highlights the need for tailored training and specific implant availability to meet the evolving healthcare demands of the Afghan population in NGO settings.