Surge Capacity Treatment for Open Fractures in the Gaza Strip: Case Reports

Treating open fractures in conflict zones, such as the Gaza Strip, is severely influenced by supply chain disruptions and shortages of medical devices. This study addresses this by evaluating the clinical application of a low-cost, locally manufacturable external fixator developed by Imperial College London. It contributes to the literature by demonstrating the viability of frugal innovation in providing surge capacity for complex trauma in an active war zone with severe resource constraints.

Two male patients, aged 21 and 13, presented to Shifa Hospital in Gaza with Gustilo-Anderson Type 3B and Type 1 open tibial fractures, respectively. Within 24 hours of admission, both underwent wound debridement and definitive stabilization using the Imperial External Fixator (iFix). Clinical follow-up assessed fracture union and device stability. Both patients achieved successful soft tissue healing and complete bone union (at 7 months and 3 months, respectively), without device failure or loosening. One patient experienced a pin-site infection, which resolved with antibiotics. Surgeons reported that the device provided satisfactory stability and intraoperative modularity comparable to commercial standards.

The low-cost Imperial external fixator proved effective as a definitive treatment for open tibial fractures in an austere, conflict-affected environment. The successful outcomes underscore that locally manufacturable, cost-effective medical devices can reliably bridge critical supply gaps, offering a scalable solution for orthopaedic surge capacity in humanitarian crises.