Gunshots and bomb blasts are important causes of injury within conflict zones and extremities are frequently affected. There is a paucity of research on the characteristics and outcomes among civilians with conflict-related extremity injuries.

We performed a prospective cohort analysis utilizing data collected during a randomized trial at two civilian hospitals in Jordan and Iraq between 2015 and 2019. Adult patients who presented within 72 hours of sustaining an extremity injury requiring surgical care were included. We used mechanism of injury (gunshot versus bomb blast) as the exposure and wound closure by day five as the primary outcome measure.

The population was predominantly young men (n=163, 94% male, median age 29 years), injured by gunshots (61%) or bomb blasts (39%). Compared to the gunshot group, participants in the bomb blast group had more concomitant injuries (32/63 [51%] vs 11/100 [11%]; p<0.001), larger wounds (median area 100 cm2 [IQR 50–145] vs 53 cm2 [IQR 25–78]; p<0.001) and more frequent infections (16/63 [25%] vs 13/100 [13%]; p=0.04). Wound closure by day five was achieved in 25% (n=16/63) of the bomb blast group and 74% (n=74/100) of the gunshot group (p<0.001). This difference remained after controlling for confounding factors (OR 4.7; 95% CI 1.6–13.7).

In this first prospective cohort analysis of civilians with acute conflict-associated injuries, those with extremity wounds caused by bomb blasts had worse outcomes than those with gunshot wounds. Our findings may prove useful to inform treatment protocols for civilians in armed conflict settings.