Orthopedic trauma and psychosocial burden in conflict-affected civilian populations of the Middle East: a systematic review and meta-analysis

Abstract Background Conflict-related orthopedic trauma causes substantial civilian morbidity, yet regional evidence remains fragmented. This review synthesizes injury patterns, complications, treatment needs, and psychosocial outcomes among civilians affected by conflict in the Middle East. Methods We systematically searched PubMed, Web of Science, and Embase as of April 24, 2026, for post-2000 studies reporting orthopedic trauma outcomes among civilians affected by armed conflict in the Middle East. Study characteristics, injury patterns, and clinical and psychosocial outcomes were extracted in duplicate. Pooled proportions were estimated using random-effects meta-analysis with logit transformation and DerSimonian–Laird estimation of between-study variance, back-transformed to the natural scale and reported with 95% confidence and prediction intervals. Heterogeneity was quantified using I², tau-squared, and Cochran’s Q, and examined further through subgroup analysis by population type and leave-one-out sensitivity analysis. Risk of bias was assessed using Joanna Briggs Institute checklists, and studies unsuitable for pooling underwent narrative synthesis. Results Thirty-three studies comprising 12,022 patients across seven conflict settings were included, of which 29 (11,181 patients) contributed to at least one pooled outcome. The pooled prevalence of amputation was 11% (95% CI 6–21%) and in-hospital mortality was 2% (95% CI 1–4%). Blast injury was the predominant mechanism at 72% (95% CI 54–85%), followed by gunshot wounds at 19% (95% CI 11–29%). Open fractures were reported in 53% (95% CI 29–76%) and infection in 34% (95% CI 19–54%). Lower extremity fractures predominated at 49% (95% CI 39–59%), and operative management was required in 71% (95% CI 53–85%). Psychiatric morbidity, chronic pain, and socioeconomic vulnerability were frequently reported. Heterogeneity was high across most outcomes, so pooled estimates should be interpreted as descriptive summaries rather than precise population-level rates. Conclusions Conflict-related orthopedic trauma in Middle Eastern civilians is characterized by blast-predominant mechanisms, high open fracture and antimicrobial-resistant infection burden, lower extremity dominance, and substantial psychiatric morbidity driven primarily by socioeconomic rather than anatomical factors. These findings highlight the need for conflict-adapted infection protocols and integrated rehabilitation frameworks addressing both physical and psychosocial recovery. To our knowledge, this is the first meta-analysis to provide pooled quantitative estimates for these outcomes in civilian conflict-affected populations of the region.