Combat Versus Civilian Open Tibia Fractures: The Effect of Blast Mechanism on Limb Salvage

Abstract

Despite current therapy, limb salvage for G-A IIIB and IIIC grades are significantly worse for open tibia fractures as a result of blast injury when compared with typical civilian mechanisms. MESS scores do not adequately predict likelihood of limb salvage in combat or civilian open tibia fractures.

Challenges in definitive fracture management of blast injuries

“…No reliable scoring system predicts which patient is best suited for acute amputation. Younger, healthier patients, even those injured by blast mechanisms, should be considered for limb salvage with a mangled extremity surgery score of 7 or less [21]. The only absolute indications for acute amputation are completion of a grossly contaminated traumatic amputation, the physiologically unstable patient with a mangled extremity, irreparable vascular injury, or an extremity with warm ischemia time greater than 6 hours.…”

Guidelines for Burn Care Under Austere Conditions

“…In comparison to civilian casualties, combat casualties have worse limb salvage rates for Gustilo-Anderson open tibia fractures grades IIIB and IIIC. 35 The blast mechanism notoriously destroys more tissue than initially may be apparent, and injects foreign material proximally along tissue planes; when in doubt, aggressive debridement and early amputation is often the best course of action. Costly and prolonged attempts at limb salvage may be ill-advised in an austere scenario.…”

Treatments and Preventative Measures for Trauma‐Induced Heterotopic Ossification: A Review

“…Recent military combat operations have heightened attention to war‐related wounds, 80% of which are caused by high‐energy explosive mechanisms. Combat injuries tend to result in a higher Injury Severity Score and also higher likelihood of HO development 12, 13. The formation of HO is reported in more than 63% of blast‐injury patients requiring amputation 14, 15, 16, 17.…”