ARTICLE INFO

Article Type

Descriptive & Survey Study

Authors

Poor Zamany Nejat Kermany   M. (1)
Masoumi   M. (*)
Modirian   E. (2)
Nouri   F. (3)
Khateri   Sh. (4)
Shokouhi   H. (5)
Soroush   M. (4)
Mohsenzadegan   A. (4)






(*) Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
(1) Anesthesiology & Critical Care Department, Medicine Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
(2) Emergency Department, Medical Faculty, Qazvin University of Medical Sciences, Qazvin, Iran
(3) Physical Medicine and Rehabilitation Department, Medicine Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
(4) Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
(5) Emergency Medicine Department, Medicine Faculty, George Washington University, Washington DC, the United States

Correspondence

Address: Janbazan Medical and Engineering Research Center (JMERC), No. 17, Farokh Street, Moghadas Ardabili Street, Yaman Street, Shahid Chamran Highway, Tehran, Iran
Phone: +982122416699
Fax: +982122416699
masoumi48@gmail.com

Article History

Received:  January  13, 2015
Accepted:  February 21, 2015
ePublished:  August 25, 2015

BRIEF TEXT


… [1-14] A huge number of the Iranian victims of the land mines are children and despite passing about 30 years from the end of Iran-Iraq war, the land mines and unexploded missiles cause injuries and mutilation in the residents of five border provinces of Iran [1, 2, 11, 15]. … [16-19]

There are not many studies about the problems of the victims of unexploded missiles and land mines in Iran [1, 2, 11, 15, 20, 21]. In addition, there are not many papers about the injured children [2, 6, 11, 22].

The aim of this study was to investigate the prevalence of pain and its relation with limb problems in the adolescent survivors of land mines and unexploded ordnances.

This is a descriptive analytical cross-sectional study.

All adolescent survivors of land mines and unexploded ordnances aged between 9 and 18years and residents of 5 Iranian border provinces including West Azarbayjan, Ilam, Kermanshah, Kurdestan, and Khuzistan were studied in Mazandaran Province (Iran) in November and December 2009 and Tehran (Iran) in January and February 2010.

Totally, 78 persons participating in two camps in Mazandaran Province and Tehran (Iran) were studied. 2 uncompleted forms were excluded.

A researcher-made questionnaire was used to collect demographic characteristics. Its reliability was assessed by experts using the collected data, and then it was standardized. The adolescents’ limb status was studied by a Physical physician. The studied parameters were pain, spinal cord pain, pain in the upper and lower limbs, skeletal complications, tendinitis and bursitis of limbs, joint contractures restrictions, neurological damages, spinal cord injuries, and physician’s order on the utilization of assistant motor vehicles. Data was analyzed, using SPSS 22 software. Chi-square test was used to investigate the correlation between age, gender, pain, province of residence, and type and location of injury and each one of the factors assessing the general health status of the limbs.

The mean age of the victims at the study time was 16.11±2.00years aged between 9 and 18 years. And the highest frequency was in 15-18 years old group (n=65; 85.5%). The mean age of the victims at the accidence time was 8.12±3.01years aged between 2 and 15years. The accidence times for male victims were approximately 6 times of the female victims. 30 persons (39.5%) and 28 persons (36.8%) were injured during a play and work in a field, respectively. 35 subjects (46.1%) were without any mutilation. From 41 amputees (53.9%), 23 subjects (56.1%) and 14 subjects (34.1%) were with mutilations in the upper and lower limbs, respectively. 3 subjects (7.3%) were with mutilations in both upper and lower limbs (Table 1). There was no kyphosis, scoliosis, kyphoscoliosis, or ectopic ossification. Nevertheless, pain was the most prevalent factor than other problems. Of the amputees, 19 persons (46.3%) and 13 persons (31.7%) needed surgery on the upper and lower limbs, respectively. The use of prosthesis on the mutilations was possible in 26 persons (63.4%), of whom 20 persons (76.92%) were using prostheses at the study time. 3 subjects (7.3%) needed other assistant motor devices, of whom 2 subjects (66.7%) needed cane, while the third one needed electric massage. There was a significant correlation between age at the study time and pain on the lower limb. Pain on the lower limb was significantly more prevalent in the adolescence aged between 15 and 18years (54.7%) than the subjects aged between 10 and 14years (25.0%). There were significant correlations between contracture and pain on the upper limb, and contracture and figure cut. Contracture in subjects with pain on the upper limb and subjects with a cut finger was highly prevalent. Tendonitis and bursitis in subjects with mutilations on the upper limb were significantly high. There was a significant correlation between any requirement for reoperation on the upper limb and upper limb mutilation. The need for operation on subjects with upper limb mutilation was crucial. The need for operation on the lower limb in subjects with pain on the lower limb was significantly crucial. There was no significant correlation between gender, general pain, and province of residence and any limb problem.

About one half of the children and adolescence injured by the land mines were with mutilations. Upper limb mutilations were more prevalent than the lower limbs, which is a result inconsistent with similar studies on the adult subjects [23-26]. There were more male subjects than female ones, which is similar to other studies [2, 6, 11, 27]. More lower-limb mutilations were under the knee, while more upper limb mutilations were on the hand fingers. There were the least frequencies of mutilations upper the elbow and upper the knee. There are higher frequencies of mutilations lower the knee and on the hand fingers among veterans with limb mutilations due to Iran-Iraq War, while there are the least frequencies of mutilations upper the elbow and the knee [6, 21, 26]. … [28] In adolescence with mutilations on the upper limb, the prevalence of tendonitis and bursitis were significantly high. Shoulder bursitis and tendonitis are the most prevalent complications in persons with upper limb mutilations [29], which is consistent with the present results. There was low prevalence of asymmetry between the bones. In persons with injuries due to the explosion of the land mines, there was a very low prevalence of neurological injuries, which is consistent with other studies [30, 31]. There were the least frequencies of wounds and trauma on the limbs. Other studies show a very limited prevalence of such problems, as well [21, 32]. About half of the persons with mutilations needed reoperation on the upper and lower limbs. Other studies show similar results [21, 26].

The status of the adolescences of the age group should be followed up regularly.

Difficult access to all the victim adolescences and lack of enough sources to compare the results were of the limitations for the present study.

Patients, who feel pain especially on the lower limb, need reoperation. The reported pain in the patients who have used prostheses might be due to a problem in the used prostheses leading to mechanical pain. Therefore, the prostheses must be replaced. High prevalence of contracture, tendonitis, and bursitis on the upper limb show a high pressure on the remaining muscles and joints after the mutilation. Therefore, especial sport exercises are necessary for the victims.

ICRC, JMERC, and Martyrs and Veterans Foundation are appreciated.

Non-declared

The study was confirmed by Ethics Committee of JMERC. Written consents had been received from the parents of the victims.

The study was funded by Center of Especial Groups of Veterans.

TABLES and CHARTS

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