Tsunami risk communication and management: Contemporary gaps and challenges

Very large tsunamis are associated with low probabilities of occurrence. In many parts of the world, these events have usually occurred in a distant time in the past. As a result, there is low risk perception and a lack of collective memories, making tsunami risk communication both challenging and complex. Furthermore, immense challenges lie ahead as population and risk exposure continue to increase in coastal areas. Through the last decades, tsunamis have caught coastal populations off-guard, providing evidence of lack of preparedness. Recent tsunamis, such as the Indian Ocean Tsunami in 2004, 2011 Tohoku and 2018 Palu, have shaped the way tsunami risk is perceived and acted upon. Based on lessons learned from a selection of past tsunami events, this paper aims to review the existing body of knowledge and the current challenges in tsunami risk communication, and to identify the gaps in the tsunami risk management methodologies. The important lessons provided by the past events call for strengthening community resilience and improvement in risk-informed actions and policy measures. This paper shows that research efforts related to tsunami risk communication remain fragmented. The analysis of tsunami risk together with a thorough understanding of risk communication gaps and challenges is indispensable towards developing and deploying comprehensive disaster risk reduction measures. Moving from a broad and interdisciplinary perspective, the paper suggests that probabilistic hazard and risk assessments could potentially contribute towards better science communication and improved planning and implementation of risk mitigation measures

Lower limb landmine injuries

The medical records of 186 patients seeking treatment for landmine injuries in the authors' re-ion between 1993 and 2001 were evaluated. Of these patients 13 died of accompanying complications. Ten (10) patients with general body trauma and upper limb trauma were excluded from the study. Of 163 patients with lower-limb injuries included in the study, 21, with traumatic amputation underwent surgical amputation at different levels. Patients without traumatic amputation were divided into 2 groups. There were 41 patients (29%) in Group I who were treated by limb salvage procedures. Treatments used in Group I including wound debridement, tendon repair, skin approximation, minimal osteosynthesis, external fixation of long bones and secondary, wound coverage. In Group 11, there were 101 patients (71%) with primary amputation. Trans-tibial amputation was performed in 52 cases (51.4%), ankle disarticulation in 24 (23.7%), trans-femoral amputation in 9 (8.9%), partial foot amputation in 8 (7.9%), knee disarticulation in 7 (6.9%) and hip disarticulation in I case. In Group 1, there was infection in 21 patients (51.2%), revision in 27 (65.8%), and amputation in 15 (36.5%). In Group 11, there was infection in 28 patients (27.7%), revision in 17 (16.8%), and amputation at a higher level in 8 (7%). In crush injuries such as those resulting from landmines, soft tissue, vascular, and neurological assessment must be performed with utmost care. Even so, the desired success in interventions intended to save a limb is complicated by a high infection rate, soft tissue complications, and high revision amputation rates. Therefore, a decision to amputate in the early term based on an accurate preoperative assessment is crucial

Treatment of intertrochanteric fractures by external fixation

In this study, we aimed to evaluate the results of treatment of intertrochanteric fractures of the femur by external fixation in 33 patients with an average age of 65.9 years. Patients in the study had Evans stable type 1 intertrochanteric fractures and unstable type 1 fractures that could be reduced to anatomical or nearly anatomical position by closed manipulation under fluoroscopy. The average follow-up period was 24 months (range, 12 to 40 months). There was no mortality in the early postoperative period, but the mortality within six month following surgery was 39%. Complete fracture healing was achieved in all patients. The fixator was removed after an average of 94 days (75 to 130 days) at the outpatient clinic. Varus malalignment of more than 20° and limb shortening greater than 2 cm were noted in 3 patients. Pin-tract infection was seen around 10 pins (7%). Osteomyelitis was not noted in any patients. Treatment of intertrochanteric fractures by external fixation is simple and can be done under local anesthesia together with narcotic analgesic support. It allows early mobilization, and implant removal is easy. Therefore we think that external fixation is a valuable alternative in high-risk geriatric patients

Use of the vastus lateralis muscle flap with a grooving procedure in the surgical treatment of chronic osteomyelitis of the femur

PubMed ID: 15602255Severe femoral fractures may be associated with devascularization of cortical bone, soft-tissue loss, and significant morbidity. After surgical treatment of these femoral fractures, chronic infection may ensue and requires additional reconstructive procedures. Local muscle flap coverage is used to treat chronic osteomyelitis. A new procedure - the vastus lateralis muscle flap with grooving of the femoral shaft - was used for the treatment of chronic osteomyelitis of the femoral shaft. The authors present 6 patients with chronic osteomyelitis of the femur who were treated with a vastus lateralis muscle flap. Five of the patients were male and the other was female. The average age of the patients was 33.8 years (range, 17-54 years). All patients experienced infection during the early postoperative period. Drainage of abscess, debridement, sequestrectomy repair of fistula, and mini fenestration were performed at least 3 times, and antibiotics were administered several times. During the operations, tissue samples were evaluated for bacterial cultivation. Staphylococcus aureus was seen in 4 patients, S. epidermidis in 1 patient, and Pseudomonas aeruginosa in the remaining patient. A vastus lateralis muscle flap with grooving of the infected femoral shaft is presented. The authors have not encountered a recurrence of infection during a minimum 3.9 years of follow-up. They think this technique is an alternative to the current techniques for the surgical treatment of chronic osteomyelitis of the femur

Valgus Angulation Osteotomy in Secondary Treatment of Femoral Neck Fractures

Fourteen patients who were operated on by various techniques for collum femoris fracture, between the years 1992 and 1998 were treated by valgus angulation osteotomy for non-union of the fracture. The average age of the patients was 45.2 years (range, 22–58 years). The osteotomy line was healed for all patients and the mean healing period was 3.6 months (range, 2.8 to 6.4 months). The nonunion of the femoral neck and the delay in uniting healed except for in one patient, and the healing period was found to be 5.8 months (range, 4.8–11 months). Including the 12 cases that had avascular necrosis at several preoperative degrees, five patients developed postoperative degenerative arthritis. During follow-ups, while the average score in the first year was 89.7, it was 85.7 in the last examination, accounting for 4% failure. For younger patients under the age of 60 who were treated with internal fixation, however nonunion, it is appropriate to perform angulation osteotomy, which is the rescuing operation, without regard to the feeding position of the head. We believe that this process will allow the union of the femoral head and, at most, lengthen the period for transition to prosthesis

The significance of tc 99m-mdp bone scintigraphy in the articular involvement of behcet's disease

[Abstract Not Available

Ileri yaşdaki hastalarda intertrokanterik kiriklarin Leinbach tipi endoprotezle tedavisi.

Intertrochanteric fractures are seen in elderly ages and occur mostly by minor trauma. Mortality and morbidity rates are high and internal fixation and external methods are used for the treatment. Twenty-seven patients with intertrochanteric fractures who were at the mean age of 78 ranging between 71-95 and were treated by Leinbach type endoprosthesis during 1995-1999 were evaluated. Fourteen (%51) patients were female and 13 (%49) were male. The patients underwent operation as early as they were convenient. If they could, they were advised to walk at the second or third day of the operation. Two (%7) patients died at the end of the operation and 1 (%3.7) patient died during the first week after the operation. The patients were followed up mean 14(5-21) months and evaluated according to the criteria of American Academy of Orthopedic Surgeons which displayed good results in %80 of patients. In elderly patients with intertrochanteric fractures due to pathologies and related complications and also complications due to immobilization are seen frequently. Treatment with endoprosthesis is thought to be helpful in decreasing these complications and early mobilization of the patients