Orthopaedic Injuries Among Survivors of USS COLE Attack

Abstract

The objective of this article is to describe the range of orthopaedic injuries and outcomes of acute treatment regimens among survivors of the USS COLE terrorist attack and to reemphasize basic treatment principles for blast injuries. With the current geopolitical environment, the average community orthopaedic surgeon may be involved in treating injuries due to an explosive terrorist attack. This is a retrospective review of a consecutive series of the 39 patients who were injured during the USS COLE attack on October 12, 2000, and were received at Naval Medical Center, Portsmouth, Virginia, from the MEDEVAC (Medical Evacuation) system. The 17 casualties from the attack were not included in this study. Data were retrospectively collected from patient charts for all patients who survived the USS COLE attack. The 39 patients who survived the USS COLE attack sustained 81 injuries. Fourteen patients sustained 32 orthopaedic injuries, of which 61% were lower extremity injuries. Of the 10 patients who required hospitalization, 6 had orthopaedic injuries (60%). Three of five open fractures (60%) became infected, and two of two (100%) open fracture wounds treated with primary closure in the initial setting were infected. Lower extremity orthopaedic injuries may predominate in a shipboard blast scenario. Even minor injuries require prolonged time before patients return to active duty. Complex wounds have high infection rates and should be treated according to previously established protocols for wartime injuries. Principles of provisional fracture stabilization prior to transport, adequate wound débridement, and delayed wound closure are reviewed.

Fractures by Firearms in Conflict Town

“…We found 9 (7.3%) cases of osteitis. This infection rate is close to the results of Keeling (8%) [12] and Moye-Elizalde (6%) [2], but is far inferior to those reported by Saidi (35.5%) [9] and Lambert (60%) [13]. Lin does not store any infection in his study [20].…”

“…For Owen, fractures by firearms are equitably distributed to lower and higher limbs [11]. However, other authors confirm the predilection of gunshot injuries to the lower limbs [1] [2] [9] [12] [13]. This preponderance of lower limbs fractures can be explained by their low lethality compared to lesions of the head and trunk which kill quickly on the field and are not recorded in the structures of care [9] [14].…”

Using biofilms as initial inocula in animal models of biofilm‐related infections

“…A Type IIIB severe fracture has been defined by Gustilo et al37 as having “extensive soft‐tissue injury loss with periosteal stripping and bone exposure” that “is usually associated with massive contamination.” Rates of infection that accompany these open fractures reach 50%38–40 and 60% in at least one reported instance 41. The potential for these fractures to be massively contaminated is highlighted by the work of Bakken42 and Torsvik et al43 who have shown that even 1 g of soil may contain between 10 7 or 10 10 bacteria, the majority of which are estimated to reside in the biofilm phenotype 35.…”

Injury Trends aboard U.S. Navy Vessels: A 50-year analysis of Mishaps at Sea

“…Throughout history, seafarers have faced unique dangers, 1–4 and the modern naval warship—part weapons systems, industrial workspace, and aerodrome conducting fixed and rotary aircraft operations—is no exception 5 . While peacetime naval deployments are generally considered safe, modern sailors face the risk of potential injury due to the associated occupational hazards, 6–14 which is significantly increased during naval warfare 15–18 …”