Challenges in definitive fracture management of blast injuries

Abstract

The United States military remains engaged in the longest armed conflict in this nation's history. The majority of casualties in the global war on terror come from blast-related injuries. Multiple centers have published their experience and outcomes with these complex patients. Findings from the study of injured military personnel have implications for mass casualty events resulting from industrial accidents or terrorism in the civilian sector. This article will review the pathophysiology of blast-related injury. The authors will summarize treatment considerations, priorities, and techniques that have proven successful. Finally, the authors will discuss the incidence and management of common complications after blast-related injuries.

Treatments and Preventative Measures for Trauma‐Induced Heterotopic Ossification: A Review

“…Recent military combat operations have heightened attention to war‐related wounds, 80% of which are caused by high‐energy explosive mechanisms. Combat injuries tend to result in a higher Injury Severity Score and also higher likelihood of HO development 12, 13. The formation of HO is reported in more than 63% of blast‐injury patients requiring amputation 14, 15, 16, 17.…”

“…However, in trauma patients, the use of prevention strategies is challenging as practicality, safety, and efficacy of systemic NSAID therapy or RT is debatable and contingent upon several factors, including severity of trauma and ectopic bone formation potential 18, 38, 39, 40. Additionally, patients with polytrauma derived HO often present with concomitant injuries that may be adversely affected by the systemic NSAID or RT 12, 14, 17. NSAID delivery following acute trauma can complicate bleeding, exacerbate gastritis, and potentially impede fracture healing 41, 42.…”

“…Excision of ectopic bone is required in approximately 20–41% of combat‐related amputees who have developed HO 22. This can be done as early as 6–8 months post‐injury without risk of recurrence in some cases 12. Excision of ectopic bone is not without complications, however, and may include severe blood loss, infection, postoperative pain management, rehabilitation obstacles, and recurrence 22.…”

“…Combat injuries tend to result in a higher Injury Severity Score and also higher likelihood of HO development. 12,13 The formation of HO is reported in more than 63% of blast-injury patients requiring amputation. [14][15][16][17] HO occurring as a result of high-energy blast injury is most commonly reported in men between 20 and 40 years of age.…”

“…18 Due to the complexity of blast-injury etiology, understanding the pathogenesis of HO resulting from multiple injury types, which simultaneously affect several bodily systems, is still under investigation. 12 Furthermore, although medical technology has improved the number of lives that can be saved after high-energy trauma injuries, this has also brought with it the opportunity for long-term complications, including HO, following life-saving surgery. 15 Much of the research thus far largely focuses on the lower limbs; however, there is a critical need for further research on upper-limb amputations and complications.…”