ORIGINAL PAPER Orthopedic trauma surgery and hospital cost analysis in refugees; the effect of the Syrian civil War Altuğ Duramaz 1 & Mustafa Gökhan Bilgili 1 & Berhan Bayram 1 & Nezih Ziroğlu 1 & Alkan Bayrak 1 & Mustafa Cevdet Avkan 1 Received: 31 August 2016 /Accepted: 16 December 2016 # SICOT aisbl 2017 Abstract Purpose The aim of this study was to evaluate the musculo- skeletal injury types, injury mechanisms, surgical techniques and treatment costs of Syrian refugees. Methods Totally 158 patients (67 female, 91 male) treated in our clinic in 34 months period between January 2012 and October 2014 were included in the study. The mean age of the patients was 39.3 years (range: 18–82 years). The patients were evaluated for age, gender, mechanism of injury, location and type of fracture, presence of accompanying injuries, inju- ry severity score, surgical technique, complications, mortality/ morbidity and treatment cost. Results The injuries were more frequently reported in lower extremities, upper extremities and axial skeleton, respectively. Blunt trauma was significantly higher in upper extremity in- juries compared with the other types of injuries (p = 0.001). Fractures were most commonly reported in foot/ankle region and in males, hand/wrist fractures were significantly higher than that of the females. Plate fixation of upper extremity fractures and intramedullary nailing in lower extremity frac- tures were the most commonly preferred treatment modalities. The mean hospitalization period of patients was 5.6 days and the mean treatment cost was 3844 Turkish Liras (TL). Conclusions In this study, it was shown that there was a sta- tistically significant increase in the cost of health expenses in patients with fall from heights or gunshot wound, with frac- tures in axial skeleton or with the ISS score between 16 and 66. The cost rise was associated with worse prognosis, complications, intensive care treatments and prolonged hospi- talization periods. Keywords Cost analysis . Orthopedic surgery . Syrian refugees . War trauma Introduction Musculoskeletal injuries compromise approximately 70% of war traumas [1]. Severe deficits are reported despite people kept alive after major injuries [2]. Though cranial, thoracic and abdominal injuries have high mortality rates, that of iso- lated musculoskeletal injuries is low [3]. Many of the muscu- loskeletal injuries in civilians are blunt and most of the victims die at the hospital during treatment [4]. Extremity injuries of civilians and soldiers are associated with the weapons used in wars [5]. Until recently, the most common cause of penetrant extremity injuries was bullets, but cluster weapons such as grenades, landmines, bomb and shrapnel subrogated them in recent conflicts [3, 6]. Lower extremity injuries are 1.5 times more common than upper extremity injuries and more than 50% of fractures are open fractures [7]. In Middle Eastern countries conflicts started with ‘The Arab Spring’ initiated the Syrian civilian war in 2011 March causing a humanitarian crisis [8]. Due to the social and med- ical problems associated with civilian war, millions of refu- gees had to immigrate to the neighbouring countries [9]. According to the records of AFAD (Turkish Government Disaster and Emergency Management Agency), till March 2016, it has been estimated that the total number of recorded and unrecorded refugees reached 2.7 million [10]. As well as financial costs, large patient populations having severe health problems without any medical records who can- not be contacted due to language limitations were inserted into * Altuğ Duramaz altug.duramaz@yahoo.com 1 Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey International Orthopaedics (SICOT) DOI 10.1007/s00264-016-3378-x