Blast Injuries: Biophysics, Pathophysiology and Management Principles

Horrocks, C. L.

doi:10.1136/jramc-147-01-03

Cited by 116 publications

(73 citation statements)

References 42 publications

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“…Wakeley [20] commented that a 'high peak overpressure is of little use if not sustained sufficiently long to distort the structure beyond its power of elastic recovery, and a large impulse is of little value if the pressure is less than the structure is able to withstand'. It has also been proposed that the dynamic overpressure of the detonation products (blast wind) and thermal energy released in the explosion contribute to blast injury [21,22]. By convention, blast injuries are classified according to the mechanism by which they are produced and their effect on the skeletal system is summarized below.…”

Section: The Physics Of Blast and Its Effect On Bonementioning

confidence: 99%

Blast-related fracture patterns: a forensic biomechanical approach

Ramasamy

Hill

Masouros

et al. 2010

J. R. Soc. Interface.

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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 ¼ 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 primary and secondary effects of the explosion. However, tertiary blast effects were the predominant mechanism of injury, with severe axial loading to the lower extremity being a characteristic of the fractures seen. The development of future mitigation strategies must focus on reducing all explosion-related injury mechanisms. Integral to this process is an urgent requirement to better understand the behaviour of bone in this unique environment.

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Section: The Physics Of Blast and Its Effect On Bonementioning

confidence: 99%

Blast-related fracture patterns: a forensic biomechanical approach

Ramasamy

Hill

Masouros

et al. 2010

J. R. Soc. Interface.

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“…2.9). Limb amputation has a grave prognosis, despite aggressive treatment, reporting that only 9 of 52 servicemen who sustained traumatic amputations from explosions in Northern Ireland survived [71]. In the lower limb, the prevalence of traumatic amputation was significantly higher (p < 0.001) at the level of the tibial tuberosity than at other sites [96], contrary to the upper limb where significant tendency was reported that more traumatic amputation occurred through distal part.…”

Section: Blast Mechanisms and Tissue Damagementioning

confidence: 86%

“…A relatively low mortality rate is apparent (up to 5%) unless the device is large, explodes in a confined space or there is structural collapse, and less than 50% of those arriving to hospital will require admission. Antipersonnel mines are characterized by a predominance of Traumatic amputation of foot or leg due to standing on a buried "point detonating" mine and the damage might be increased due to shrapnel [71].…”

Section: Blast Mechanisms and Tissue Damagementioning

confidence: 99%

Wound Ballistics and Tissue Damage

Rozen

Dudkiewicz

2011

Armed Conflict Injuries to the Extremities

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With globally increasing war, conflicts and terrorism acts, blast or bullet limb injuries are seen more often and present a surgical challenge.The amount of tissue damage and the injury severity of gunshot injuries are due to the energy transmitted by the bullets or projectiles, depending mainly on their velocity. Therefore, the injuries are not divided any more, as in the past, to "high-and low-velocity injury" but to "a high-or low-energy injury."Blast injuries are also energy related and mainly dependent upon the distance from the blast, the energy released from the bombing device, the media (air or water) and the environment in which the blast takes place (close or open). Although the injury may look superficial, it might be much worse and the external wound is sometimes only the tip of the iceberg. Bullet and Projectile BallisticsProjectile or bullet injuries may be classified as "lowenergy" or "high-energy," which describe the amount of damage to the tissues. The factor that most affects the injury severity is the amount and the efficiency of energy transfer [1][2][3][4][5], which is mostly related to kinetic energy that is presented by the equation2 ] (M -mass; V -velocity)" in a bullet that does not "waste" energy on deforming. Other suggested theories are the momentum theory expressed as "Mass × Velocity" and the power theory related to "Mass × Velocity 3 " [6]. Ballistic wounds can be classified, according to the amount of energy causing them, into: high energy (>1,000 J); medium energy (250-1,000 J); low energy (<250 J) [7]. For example, this is the basic principle of successful open fracture classification system as described by GustiloAnderson [8,9].The energy importance is represented by most shot wound classifications, such as the Red Cross classification for war injury [10] that emphasizes wound severity in terms of tissue damage and injuries to specific anatomic structures. The injury is rated according to the size of the entry and exit wounds. It also categorizes the presence of a cavity, a fracture, or an injured vital structure and the presence or absence of metallic bodies [10]. The modified Red Cross classification for civilian injuries, [11] which incorporates the ballistic and clinical aspects of gunshot injuries in civilians, is based on energy dissipation, vital structures injured, type of wound created, severity of bony injury, degree of contamination, and the modified Gustilo-Anderson open fracture classification system in which lowvelocity gunshot wounds are designated as Grade I or Grade II, based on the size of the skin wound and highvelocity gunshot injuries are designated as Grade III injuries, regardless of wound size [12].The cascade of a shot starts with pulling the trigger. This leads to the quick expansion of gas that may reach a temperature of over 2,800°C. This produces

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“…Wakeley (1945) commented that a 'high peak overpressure is of little use if not sustained sufficiently long to distort the structure beyond its power of elastic recovery, and a large impulse is of little value if the pressure is less than the structure is able to withstand.' It has also been proposed that the dynamic overpressure of the detonation products (blast wind) and thermal energy released in the explosion contribute to blast injury (Cullis, 2001;Horrocks, 2001). Traditionally, blast injuries are classified according to the mechanism by which they are produced and these are summarised below (Zuckerman, 1952) (Table 1).…”

Section: The Physics Of Blastmentioning

confidence: 99%

The effects of explosion on the musculoskeletal system

Ramasamy

Hughes

Carter

et al. 2013

Trauma

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Explosions remain the leading cause of death and injury to combatants in conflict. The current 'Global War on Terror' has resulted in a shift of explosive-related injuries from the battlefield into civilian centres. Despite musculoskeletal injuries being the most common injury witnessed in blast, there remains little research into the effects of blast on this system. In order to develop new treatment regimens and mitigation systems, there is a requirement to have a better understanding of skeletal trauma in this unique environment. The aim of this review article is to deconstruct the complex injury mechanisms witnessed in blast and relate them to its effects on the musculoskeletal system.

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Blast Injuries: Biophysics, Pathophysiology and Management Principles

Cited by 116 publications

References 42 publications

Blast-related fracture patterns: a forensic biomechanical approach

Blast-related fracture patterns: a forensic biomechanical approach

Wound Ballistics and Tissue Damage

The effects of explosion on the musculoskeletal system

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