Extremity injuries sustained by the UK military in the Iraq and Afghanistan conflicts: 2003–2014

Chandler, Henry; MacLeod, Kirsty; Penn-Barwell, Jowan G.

doi:10.1016/j.injury.2017.05.022

“…Similarly, in the literature, the rate of open fractures (61.5%-83%) is reported to be higher than that of closed fractures (4,9,10).…”

Section: Discussionmentioning

confidence: 72%

“…Studies on blast and war traumas reveal that musculoskeletal system injuries constitute 65-70% of all injuries reported from the first world war to the Somalia civil war in 1992 (1,2). This is also supported by most of the injuries during the 2003-2014 Iraq and Afghanistan conflicts being observed on the extremities (3,4).…”

Section: Introductionmentioning

confidence: 95%

Bomb Blast: Imaging Findings, Treatment and Clinical Course of Extremity Traumas

Tahtabaşı¹,

Er

²

,

Karasu

³

et al. 2020

Preprint

0

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Background: To determine the severity and types of blast-related extremity injuries and the presence of accompanying vascular injuries (VI) and amputation, and to identify the predictive factors affecting the treatment management and clinical course. Methods: The study included 101 patients with extremity injuries caused by a bomb explosion. The radiographs and computed tomography angiographies of the patients were evaluated in terms of injury patterns, presence of shrapnel fragments and fractures, and localization (upper or lower extremity) and type (open or closed) of injury. In addition, the presence of soft tissue injuries and VI was recorded. The Gustilo-Anderson classification was used for open fractures. According to their severity, open fractures classified as types 1, 2 and 3A were included in Group 1 and those classified as type 3B and 3C in Group 2. Results: As a result of the explosion, 101 (57.7%) patients had extremity injuries, of which 76 (75.2%) presented with at least one fracture. Of the total of 103 fractures, nine (8.8%) were closed and 94 (91.2%) were open. Thirty-eight (40.4%) of the open fractures were located in the upper extremities,and 56 (59.6%) in the lower extremities and pelvis. Open fractures were most frequently localized in the femur (n=20; 21.2%), followed by the tibia (n=18; 19.1%

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“…While terrorism was a problem of only underdeveloped and developing countries in the past, it now presents as a global problem affecting innocent civilians worldwide and results in widespread fear, injury, chaos, and death (7). In recent years, the world has been subjected to the devastating effects of many terrorist attacks, such as the bombings of 2001 New York, 2004 Madrid train, 2005 London metro, 2013 Boston marathon, 2015 Ankara, and 2003-2014 Iraq and Afghanistan con icts (4,5,8).…”

Section: Discussionmentioning

confidence: 99%

“…Studies on blast and war traumas reveal that musculoskeletal system injuries constitute 65-70% of all injuries reported from the rst world war to the Somalia civil war in 1992 (1,2). This is also supported by most of the injuries during the 2003-2014 Iraq and Afghanistan con icts being observed on the extremities (3,4).…”

Section: Introductionmentioning

confidence: 95%

Bomb Blast: Imaging Findings, Treatment and Clinical Course of Extremity Traumas

Tahtabaşı

¹

,

Er

²

,

Karasu

³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: To determine the severity and types of blast-related extremity injuries and the presence of accompanying vascular injuries (VI) and amputation, and to identify the predictive factors affecting the treatment management and clinical course. Methods: The study included 101 patients with extremity injuries caused by a bomb explosion. The radiographs and computed tomography angiographies of the patients were evaluated in terms of injury patterns, presence of shrapnel fragments and fractures, and localization (upper or lower extremity) and type (open or closed) of injury. The Gustilo-Anderson classification was used for open fractures. According to their severity, open fractures classified as types 1, 2 and 3A were included in Group 1 and those classified as type 3B and 3C in Group 2. Results: As a result of the explosion, 101 (57.7%) patients had extremity injuries, of which 76 (75.2%) presented with at least one fracture. Of the total of 103 fractures, nine (8.8%) were closed and 94 (91.2%) were open. Thirty-eight (40.4%) of the open fractures were located in the upper extremities, and 56 (59.6%) in the lower extremities and pelvis. Open fractures were most frequently localized in the femur (n=20; 21.2%), followed by the tibia (n=18; 19.1%). The majority of patients with open fractures were in Group 1 (74.2%). The duration of hospital stay was longer in Group 2 (11.7±5.8 vs. 6.8±6.7 days, p <0.0001). Mortality among patients in Group 2 (44.4%) was significantly higher than in Group 1 (6.1%) ( p <0.0001). Similarly, the injury severity score (ISS) was higher in Group 2 (median 20 vs. 9, p<0.0001). Similarly, the rate of VI was higher in Group 2 (66.1%) than in Group 1 (2.4%) ( p <0.0001). VI was present in 13 (12.9%) of all patients, and amputation in seven (7.9%). Conclusion: The presence of severe open fractures, VI, and high ISS score can be considered as important factors that increase morbidity and mortality. In extremity traumas, through the secondary blast mechanism, contaminated-fragmented tissue injuries occur. Therefore, we believe that it will be beneficial to apply damage control surgery in places with low socioeconomic level and poor hygienic conditions.

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“…With the variables that require control in order to preserve objectivity and scientific rigour, reproducing highquality experiments is arduous for any researcher. With previous studies having explored or commented upon the survivorship burden from conflicts throughout the twentieth century, extremity gunshot wounding (GSW) is often noted to make up the largest proportion of injuries [1][2][3][4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Preliminary effect of projectile yaw on extremity gunshot wounding in a cadaveric animal model: a serendipitous study

Stevenson

¹

,

Carr

²

,

Gibb³

et al. 2020

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Gunshot wounding (GSW) is capable of causing devastating tissue injuries by delivering kinetic energy (KE) through the contact surface area of a projectile. The contact surface area can be increased by yaw, deformation and fragmentation, all of which may be caused by any intermediate layers struck by the projectile prior to entering its target. This study aims to describe whether projectile yaw occurring before penetration of a cadaveric animal limb model causes greater damage with or without clothing layers present using 5.45 × 39 mm projectiles. In total, 12 fallow deer hind limbs were shot, further divided into 4 with no clothing layers (C nil ), 4 with a single clothing layer (C min ) and 4 with maximum clothing layers (C max ) as worn on active duty by UK military personnel. Contrast computed tomography (CT) of limbs was used to measure permanent cavity size and the results were compared using analysis of variance (ANOVA). No significant differences were found among clothing states for each series of measurements taken, with greater cavity sizes noted in all clothing states. This is in contrast to previous work looking at symmetrically flying projectiles in the same model, where a larger permanent cavity was found only with C max present. Projectile yaw is therefore likely to be a key variable with regard to causation of damage within this extremity wound model. & Cranfield University personnel-Clare Pratchett for the included artwork schematics; Alan Peare for his assistance with range work

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Extremity injuries sustained by the UK military in the Iraq and Afghanistan conflicts: 2003–2014

Cited by 46 publications

References 16 publications

Bomb Blast: Imaging Findings, Treatment and Clinical Course of Extremity Traumas

Bomb Blast: Imaging Findings, Treatment and Clinical Course of Extremity Traumas

Bomb Blast: Imaging Findings, Treatment and Clinical Course of Extremity Traumas

Preliminary effect of projectile yaw on extremity gunshot wounding in a cadaveric animal model: a serendipitous study

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