Suchergebnisse

Improved protective measures and medical care has increased the survivability from battlefield injuries. In an attempt to reduce the debilitating consequences of blast injury, understanding and mitigating the effects of explosion on the extremities is key. In this study, forensic biomechanical analyses have been applied to determine mechanisms of injury after the traumatic event. The aims of this study were (i) to determine which effects of the explosion are responsible for combat casualty extremity bone injury in two distinct environments, namely open, free-field (open group), and in vehicle or in cover (enclosed group), and (ii) to determine whether patterns of combat casualty bone injury differed between environments. Medical records of casualties admitted to a military hospital in Afghanistan were reviewed over a six-month period. Explosive injuries have been sub-divided traditionally into primary, secondary and tertiary effects. All radiographs were independently reviewed by a military radiologist, a team of military orthopaedic surgeons and a team of academic biomechanists, in order to determine 'zones of injury' (ZoIs), and their related mechanisms. Sixty-two combat casualties with 115 ZoIs were identified. Thirty-four casualties in the open group sustained 56 ZoIs; 28 casualties in the enclosed group sustained 59 ZoIs. There was no statistical difference in mean ZoIs per casualty between groups (p = 0.54). There was a higher proportion of lower limb injuries in the enclosed group compared with the open group (p < 0.05). Of the casualties in the open group, 1 ZoI was owing to the primary effects of blast, 10 owing to a combination of primary and secondary blast effects, 23 owing to secondary blast effects and 24 owing to tertiary blast effects. In contrast, tertiary blast effects predominated in the enclosed group, accounting for 96 per cent of ZoIs. These data clearly demonstrate two distinct injury groups based upon the casualties' environment. The enclosed environment appears to attenuate the ...

Intro -- Foreword -- Preface -- Contents -- Part I: Basic Science and Engineering -- 1: Section Overview -- 2: The Fundamentals of Blast Physics -- 2.1 Explosives and Blast: A Kinetic Effect -- 2.2 Explosive Systems: The Explosive Train -- 2.3 Energy Levels and Energy Distribution -- 2.4 Formation and Velocity of Fragments -- 2.5 Shock and Stress Transmission -- 2.5.1 Wave Type -- 2.5.2 Magnitude of the Wave -- 2.5.3 Impedance: A Property of the Material -- 2.5.4 Wave Transmission Across Interfaces -- 2.5.5 The Solid-Air Interface -- 2.6 Blast Waves -- 2.6.1 Change in Impedance of a Gas in a Blast Wave -- 2.6.2 Reflected Waves -- 2.6.3 Temperature Rise -- 2.7 Comparing Explosive Scenarios: Scaled Distance and TNT Equivalence -- 2.8 The Three-Dimensional World and the Physical Basis of Blast and Fragment Injury -- 2.9 Summary/Conclusion -- References -- Further Reading -- 3: Biomechanics in Blast -- 3.1 Overview -- 3.2 Terminology in Biomechanics -- 3.2.1 Biomechanics of Motion -- 3.2.2 Forces -- 3.2.3 Newton's Laws and Kinetics -- 3.2.4 Functional Anatomy -- 3.3 Biomechanics of Force Transmission -- 3.3.1 Muscle Forces -- 3.3.2 Forces in Joints -- 3.4 Bringing it All Together: Forensic Biomechanics of Blast -- References -- Further Reading -- 4: Behaviour of Materials -- 4.1 Introduction -- 4.2 Materials -- 4.2.1 Metals -- 4.2.1.1 Microstructure -- 4.2.1.2 Imperfections -- 4.2.1.3 Hardening -- 4.2.1.4 Main Industrial Alloys -- Steel -- Cast Iron -- Copper Alloys -- Alloys of Light Metals -- 4.2.2 Ceramics -- 4.2.3 Polymers -- 4.2.3.1 Thermoplastics -- 4.2.3.2 Thermosets -- 4.2.3.3 Elastomers or Rubbers -- 4.2.4 Composites -- 4.2.5 Biological Materials -- 4.2.5.1 Biological Fluids -- Protoplasm -- Mucus -- Synovial Fluid -- 4.2.5.2 Biological Solids -- Actin and Elastin -- Collagen -- 4.3 Stress Analysis.

INTRODUCTION: The Afghanistan war (2003–2014) was a unique period in military medicine. Many service personnel survived injuries of a severity that would have been fatal at any other time in history; the long-term health outcomes of such injuries are unknown. The ArmeD SerVices TrAuma and RehabilitatioN OutComE (ADVANCE) study aims to determine the long-term effects on both medical and psychosocial health of servicemen surviving this severe combat related trauma. METHODS AND ANALYSIS: ADVANCE is a prospective cohort study. 1200 Afghanistan-deployed male UK military personnel and veterans will be recruited and will be studied at 0, 3, 6, 10, 15 and 20 years. Half are personnel who sustained combat trauma; a comparison group of the same size has been frequency matched based on deployment to Afghanistan, age, sex, service, rank and role. Participants undergo a series of physical health tests and questionnaires through which information is collected on cardiovascular disease (CVD), CVD risk factors, musculoskeletal disease, mental health, functional and social outcomes, quality of life, employment and mortality. ETHICS AND DISSEMINATION: The ADVANCE Study has approval from the Ministry of Defence Research Ethics Committee (protocol no:357/PPE/12) agreed 15 January 2013. Its results will be disseminated through manuscripts in clinical/academic journals and presentations at professional conferences, and through participant and stakeholder communications. TRIAL REGISTRATION NUMBER: The ADVANCE Study is registered at ISRCTN ID: ISRCTN57285353.

Abstract
Background
Limb salvage by ortho-plastic teams is the standard protocol for treating open tibial fractures in high-income countries, but there's limited research on this in conflict settings like the Gaza Strip. This study assessed the clinical impact of gunshot-related open tibial fractures, compared patient management by orthopedic and ortho-plastic teams, and identified the risk factors for bone non-union in this context.

Methods
A retrospective review of medical records was conducted on Gaza Strip patients with gunshot-induced-open tibial fractures from March 2018 to October 2020. Data included patient demographics, treatments, and outcomes, with at least one year of follow-up. Primary outcomes were union, non-union, infection, and amputation.

Results
The study included 244 injured individuals, predominantly young adult males (99.2%) with nearly half (48.9%) having Gustilo-Anderson type IIIB fractures and more than half (66.8%) with over 1 cm of bone loss. Most patients required surgery, including rotational flaps and bone grafts with a median of 3 admissions and 9 surgeries. Ortho-plastic teams managed more severe muscle and skin injuries, cases with bone loss > 1 cm, and performed less debridement compared to other groups, though these differences were not statistically significant. Non-union occurred in 53% of the cases, with the ortho-plastic team having the highest rate at 63.6%. Infection rates were high (92.5%), but no significant differences in bone or infection outcomes were observed among the different groups. Logistic regression analysis identified bone loss > 1 cm, vascular injury, and the use of a definitive fixator at the first application as predictors of non-union.

Conclusions
This study highlights the severity and complexity of such injuries, emphasizing their significant impact on patients and the healthcare system. Ortho-plastic teams appeared to play a crucial role in managing severe cases. However, further research is still needed to enhance our understanding of how to effectively manage these injuries.