Imaging of Blast Injuries to the Lower Extremities Sustained in the Boston Marathon Bombing

Guermazi, Ali; Hayashi, Daichi; Smith, Stacy E.; Palmer, William E.; Katz, Jeffrey N.

doi:10.1002/acr.22113

Cited by 13 publications

(11 citation statements)

References 16 publications

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“…12 In the Partner's cohort, the shrapnel fragments were identified most often in the leg (36.5%), thigh (31.2%), and pelvis (13.2%), with the remaining 19.1% located above the pelvis. Soft tissues of the leg, thigh, and pelvis accounted for 153 (80.9%) of the 189 shrapnel fragments identified.…”

Section: Secondary Blast Injuriesmentioning

confidence: 98%

“…Both technical and professional staffing resources should be prepared to streamline examination performance, interpretation, and results communication. 7 Guermazi et al 12 published a musculoskeletal injury-specific imaging algorithm for blast injuries, which we have modified to be more general (Fig. 7).…”

Section: Imaging Strategy For Blast Injuriesmentioning

confidence: 98%

“…Soft tissues of the leg, thigh, and pelvis accounted for 153 (80.9%) of the 189 shrapnel fragments identified. 6,12 Indeed, the positioning resulted in multiple traumatic amputations, all of which were lower extremity amputations for patients seen at BWH and MGH.…”

Section: Secondary Blast Injuriesmentioning

confidence: 99%

See 2 more Smart Citations

Terrorist Bombings: Foreign Bodies from the Boston Marathon Bombing

Brunner

Singh

Rocha

et al. 2015

Seminars in Ultrasound, CT and MRI

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Section: Secondary Blast Injuriesmentioning

confidence: 98%

Section: Imaging Strategy For Blast Injuriesmentioning

confidence: 98%

See 1 more Smart Citation

Terrorist Bombings: Foreign Bodies from the Boston Marathon Bombing

Brunner

Singh

Rocha

et al. 2015

Seminars in Ultrasound, CT and MRI

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“…84 Amputations are the unfortunate end result of the most extreme of these injuries and reported to occur in 1-3% of blast victims. 84,85 Acute wound care accompanied by associated infections may highly impact occupational health.…”

Section: Acute Woundsmentioning

confidence: 99%

Human Wounds and Its Burden: An Updated Compendium of Estimates

Sen

2019

Advances in Wound Care

787

559

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A 2018 retrospective analysis of Medicare beneficiaries identified that *8.2 million people had wounds with or without infections. Medicare cost estimates for acute and chronic wound treatments ranged from $28.1 billion to $96.8 billion. Highest expenses were for surgical wounds followed by diabetic foot ulcers, with a higher trend toward costs associated with outpatient wound care compared with inpatient. Increasing costs of health care, an aging population, recognition of difficult-to-treat infection threats such as biofilms, and the continued threat of diabetes and obesity worldwide make chronic wounds a substantial clinical, social, and economic challenge. Recent Advances: Chronic wounds are not a problem in an otherwise healthy population. Underlying conditions ranging from malnutrition, to stress, to metabolic syndrome, predispose patients to chronic, nonhealing wounds. From an economic point of view, the annual wound care products market is expected to reach $15-22 billion by 2024. The National Institutes of Health's (NIH) Research Portfolio Online Reporting Tool (RePORT) now lists wounds as a category. Future Directions: A continued rise in the economic, clinical, and social impact of wounds warrants a more structured approach and proportionate investment in wound care, education, and related research.

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“…Thus, even victims who have apparently minimal injury can need radiological investigation. 21,25 In a review published by Sosna et al, 26 which included a workflow chart for the imaging of terror victims, the authors have emphasized the importance of fast and accurate imaging in triage and evaluation of injuries. Radiographs are usually helpful in the triage of patients for further imaging with CT, particularly when metallic fragments are identified.…”

Section: Discussionmentioning

confidence: 99%

Imaging features of blast injuries: experience from 2015 Ankara bombing in Turkey

Yazgan¹,

Aksu²

2016

BJR

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Objective: To present the radiological features of blastrelated injuries in the victims of the 10 October 2015 Ankara bombing and emphasize the importance of imaging. Methods: This retrospective descriptive study included a total of 28 patients who underwent CT scan or radiographic imaging within 6 h after the bombing on 10 October 2015. CT scans and plain radiographs were evaluated regarding mechanisms of injuries. Injuries were categorized as primary, secondary, tertiary and quaternary. The number of shrapnel and distribution of injuries were noted. Injury Severity Score (ISS) was used to rank the severity of the injury. Results: Primary blast injuries consisted of only tympanic membrane rupture. A high rate of patients (21/28 patients) in the study group suffered from secondary blast injuries. Tertiary injuries were detected in only three patients. Of the severely injured patients, five had abdominal injuries, three had thoracic injuries and six had extremity injuries. ISS was significantly higher in patients with thoracic and abdominal injuries. Conclusion: Our results after the suicide bomb attacks showed that the most common injury pattern was secondary blast injury. The torso was the most commonly injured body region, followed by the extremities. This specific injury pattern requires the use of immense radiological imaging. Hence, radiologists should be aware of the mechanisms and spectrums of blast-related injuries. Advances in knowledge: Both the unique injury pattern and the following chaos make blast-related injuries a challenge in terms of triage, diagnosis and management. Radiologists should be familiar with the wide spectrum of these unique injuries. INTRODUCTION Mechanisms of injuryThe patterns of blast-related injuries are categorized according to the basic effect of explosion (Table 1). This categorization provides a valuable theoretical framework for understanding blast injuries. However, various mechanisms occur together and victims usually have complicated injuries.1,2 Primary injuries occur secondary to the direct effect of changes in the atmospheric pressure caused by the blast wave, which is an intense over-pressurization impulse created by the explosion. Gas-filled structures such as the middle ear, lung and the gastrointestinal tract are most susceptible. Secondary blast injuries result from flying debris and fragments. They can be seen in any part of the body and are considered to be the most common cause of explosion-related injuries. Fragments would be metallic (shrapnel) or non-metallic. Furthermore, bony fragments from other individuals can be encountered. Tertiary blast injuries occur when the victim body is thrown over by the blast wind producing blunt or penetrating trauma. Quaternary blast injuries are caused by burns, toxic inhalation and exposure to radiation.

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Imaging of Blast Injuries to the Lower Extremities Sustained in the Boston Marathon Bombing

Cited by 13 publications

References 16 publications

Terrorist Bombings: Foreign Bodies from the Boston Marathon Bombing

Terrorist Bombings: Foreign Bodies from the Boston Marathon Bombing

Human Wounds and Its Burden: An Updated Compendium of Estimates

Imaging features of blast injuries: experience from 2015 Ankara bombing in Turkey

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