(iii) Military limb injuries/ballistic fractures

Griffiths, D; Clasper, Jon

doi:10.1016/j.cuor.2006.07.007

Cited by 22 publications

(10 citation statements)

References 22 publications

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“…Normally, decontamination products have only transient contact with body surfaces. However, with potentially long evacuation times (Alam et al, ; Griffiths and Clasper, ; Mabry et al, ; Spalding et al, ), removal of wound dressings may be delayed in combat conditions; thus, the extended contact time used in this current study provides a more appropriate evaluation of product efficacy for wound decontamination.…”

Section: Discussionmentioning

confidence: 99%

Development of haemostatic decontaminants for treatment of wounds contaminated with chemical warfare agents. 3: Evaluation of in vitro topical decontamination efficacy using damaged skin

et al. 2017

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Previous studies have demonstrated that haemostatic products with an absorptive mechanism of action retain their clotting efficiency in the presence of toxic materials and are effective in decontaminating chemical warfare (CW) agents when applied to normal, intact skin. The purpose of this in vitro study was to assess three candidate haemostatic products for effectiveness in the decontamination of superficially damaged porcine skin exposed to the radiolabelled CW agents, soman (GD), VX and sulphur mustard (HD). Controlled physical damage (removal of the upper 100 μm skin layer) resulted in a significant enhancement of the dermal absorption of all three CW agents. Of the haemostatic products assessed, WoundStat™ was consistently the most effective, being equivalent in performance to a standard military decontaminant (fuller's earth). These data suggest that judicious application of haemostatic products to wounds contaminated with CW agents may be a viable option for the clinical management of casualties presenting with contaminated, haemorrhaging injuries. Further studies using a relevant animal model are required to confirm the potential clinical efficacy of WoundStat™ for treating wounds contaminated with CW agents. Copyright © 2017 John Wiley & Sons, Ltd.

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Section: Discussionmentioning

confidence: 99%

Development of haemostatic decontaminants for treatment of wounds contaminated with chemical warfare agents. 3: Evaluation of in vitro topical decontamination efficacy using damaged skin

et al. 2017

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“…Much has been made in the literature about the importance of understanding the ballistics of GSW fractures in order to guide treatment of these injuries. 10,[14][15][16] Their destructive nature results in problems with union and infection. The magnitude of tissue damaged by a bullet depends on its velocity, mass, size, shape, tumbling features and the character of tissue it strikes.…”

Section: Discussionmentioning

confidence: 99%

Gunshot tibia fractures treated with intramedullary nailing: A single centre retrospective review

Hilton

Kruger

Wiese³

et al. 2017

SA orthop. j.

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Background: Open tibia fractures are notoriously difficult to treat, with a high rate of union problems and infection. Gunshot wound-associated fractures of the tibia compound these issues further by causing extensive bone comminution and soft tissue damage. No universally accepted management protocol exists, but intramedullary (IM) nailing of these injuries is an attractive treatment strategy. It provides stable internal fixation and limits further insult to the soft tissue envelope. It also allows complete access for wound management and early range of movement of the adjacent joints. This study aims to review the results of patients treated with IM nailing for gunshot wound (GSW) tibia fractures to assess whether this is a viable treatment option for this injury.Methods: A retrospective folder review was performed of all adult patients who sustained a GSW tibia fracture treated with intramedullary nailing between January 2009 and December 2014. Parameters evaluated included time to theatre, time to wound closure, radiographic extent of fracture comminution, anatomical alignment, time to union and incidence of chronic osteomyelitis.Results: Twenty-two patients were eligible for inclusion; however, nine were lost to follow-up. The remaining 13 patients achieved union over an average of 26 weeks. Three cases developed osteomyelitis, all of which had radiographic zones of comminution exceeding 120 mm. No cases of malunion were reported and no other significant trends noted.Conclusion: Treatment of tibial gunshot fractures must be individualised according to both the soft tissue injury and radiographic zone of comminution in order to achieve a favourable outcome. Intramedullary nailing is an effective treatment strategy for low Gustilo-Anderson grade injuries, with minimal complications.

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“…Recent operations in Afghanistan have shown casualty evacuation times from the point of wounding to hospital of 75 min,28 and this may be an emerging trend in more asymmetric conflicts. However, in more traditional scenarios such as the first Gulf War of 1991, the mean time taken from injury to arriving at a British surgical hospital was 10.2 h and by the second Gulf War of 2003, with much shorter lines of communication and better casualty evacuation, the mean delay was still 6 h 29. This contrasts markedly with reports from the civilian environment.…”

Section: Discussionmentioning

confidence: 85%

Identifying future ‘unexpected’ survivors: a retrospective cohort study of fatal injury patterns in victims of improvised explosive devices

Singleton

Gibb²,

Hunt

et al. 2013

BMJ Open

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ObjectivesTo identify potentially fatal injury patterns in explosive blast fatalities in order to focus research and mitigation strategies, to further improve survival rates from blast trauma.DesignRetrospective cohort study.ParticipantsUK military personnel killed by improvised explosive device (IED) blasts in Afghanistan, November 2007–August 2010.SettingUK military deployment, through NATO, in support of the International Security Assistance Force (ISAF) mission in Afghanistan.Data sourcesUK military postmortem CT records, UK Joint Theatre Trauma Registry and associated incident data.Main outcome measuresPotentially fatal injuries attributable to IEDs.ResultsWe identified 121 cases, 42 mounted (in-vehicle) and 79 dismounted (on foot), at a point of wounding. There were 354 potentially fatal injuries in total. Leading causes of death were traumatic brain injury (50%, 62/124 fatal injuries), followed by intracavity haemorrhage (20.2%, 25/124) in the mounted group, and extremity haemorrhage (42.6%, 98/230 fatal injuries), junctional haemorrhage (22.2%, 51/230 fatal injuries) and traumatic brain injury (18.7%, 43/230 fatal injuries) in the dismounted group.ConclusionsHead trauma severity in both mounted and dismounted IED fatalities indicated prevention and mitigation as the most effective strategies to decrease resultant mortality. Two-thirds of dismounted fatalities had haemorrhage implicated as a cause of death that may have been anatomically amenable to prehospital intervention. One-fifth of the mounted fatalities had haemorrhagic trauma which currently could only be addressed surgically. Maintaining the drive to improve all haemostatic techniques for blast casualties, from point of wounding to definitive surgical proximal vascular control, alongside the development and application of novel haemostatic interventions could yield a significant survival benefit. Prospective studies in this field are indicated.

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(iii) Military limb injuries/ballistic fractures

Cited by 22 publications

References 22 publications

Development of haemostatic decontaminants for treatment of wounds contaminated with chemical warfare agents. 3: Evaluation of in vitro topical decontamination efficacy using damaged skin

Development of haemostatic decontaminants for treatment of wounds contaminated with chemical warfare agents. 3: Evaluation of in vitro topical decontamination efficacy using damaged skin

Gunshot tibia fractures treated with intramedullary nailing: A single centre retrospective review

Identifying future ‘unexpected’ survivors: a retrospective cohort study of fatal injury patterns in victims of improvised explosive devices

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