Spinal Fractures in Current Military Deployments

Eardley, William; Bonner, T.J.; Gibb, Iain

doi:10.1136/jramc-158-02-06

Cited by 7 publications

(3 citation statements)

References 33 publications

(45 reference statements)

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“…Basic research is evaluating the behavior of ligaments and vertebral bodies at high strain rates similar to those seen in blast [ 4 , 5 , 10 ]. These can be correlated with work on the injury patterns seen in blast to attempt to derive the posture of the spine at the moment of failure and to postulate the mechanism of failure [ 7 , 12 , 22 ]. For example, Lehman et al [ 15 ] suggest that in underbody blast, the use of body armor by soldiers reduces the mobility of the upper lumbar spine and increases the risk of low lumbar burst fractures.…”

Section: Discussionmentioning

confidence: 99%

Blast Injury in the Spine: Dynamic Response Index Is Not an Appropriate Model for Predicting Injury

Spurrier

Singleton

Masouros

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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BackgroundImprovised explosive devices are a common feature of recent asymmetric conflicts and there is a persistent landmine threat to military and humanitarian personnel. Assessment of injury risk to the spine in vehicles subjected to explosions was conducted using a standardized model, the Dynamic Response Index (DRI). However, the DRI was intended for evaluating aircraft ejection seats and has not been validated in blast conditions.Questions/purposesWe asked whether the injury patterns seen in blast are similar to those in aircraft ejection and therefore whether a single injury prediction model can be used for both situations.MethodsUK military victims of mounted blast (seated in a vehicle) were identified from the Joint Theatre Trauma Registry. Each had their initial CT scans reviewed to identify spinal fractures. A literature search identified a comparison population of ejected aircrew with spinal fractures. Seventy-eight blast victims were identified with 294 fractures. One hundred eighty-nine patients who had sustained aircraft ejection were identified with 258 fractures. The Kruskal-Wallis test was used to compare the population injury distributions and Fisher’s exact test was used to assess differences at each spinal level.ResultsThe distribution of injuries between blast and ejection was not similar. In the cervical spine, the relative risk of injury was 11.5 times higher in blast; in the lumbar spine the relative risk was 2.9 times higher in blast. In the thoracic spine, the relative risk was identical in blast and ejection. At most individual vertebral levels including the upper thoracic spine, there was a higher risk of injury in the blast population, but the opposite was true between T7 and T12, where the risk was higher in aircraft ejection.ConclusionsThe patterns of injury in blast and aircraft are different, suggesting that the two are mechanistically dissimilar. At most vertebral levels there is a higher relative risk of fracture in the blast population, but at the apex of the thoracic spine and in the lower thoracic spine, there is a higher risk in ejection victims. The differences in relative risk at different levels, and the resulting overall different injury patterns, suggest that a single model cannot be used to predict the risk of injury in ejection and blast.Clinical RelevanceA new model needs to be developed to aid in the design of mine-protected vehicles for future conflicts.

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Section: Discussionmentioning

confidence: 99%

Blast Injury in the Spine: Dynamic Response Index Is Not an Appropriate Model for Predicting Injury

Spurrier

Singleton

Masouros

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…One hundred twenty-eight spinal fractures during military deployments of the United Kingdom army between 2005-2009 were collected. 40 Ballistic (79%) and nonballistic mechanisms contribute to vertebral fracture, a high incidence of lumbar spine fractures, which are more likely to be due to explosion than gunshot wounding. The authors concluded that due to the predominance of explosive injury in current conflicts, and the research must be directed to this injury mechanism.…”

Section: War and Combat Injuriesmentioning

confidence: 99%

“…The authors concluded that due to the predominance of explosive injury in current conflicts, and the research must be directed to this injury mechanism. 40 War injuries have also been an interest of some studies. The US army collected 65 cases of explosive device assaults on uparmored vehicles during the Afghanistan and Iraq wars.…”

Section: War and Combat Injuriesmentioning

confidence: 99%

Incidence and Epidemiology of Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations

2021

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This review aims to search the epidemiology and incidence rates of thoracolumbar spine fractures. A systematic review of the literature of the last 10 years gave 586 results with “incidence,” and 387 results with “epidemiology,” of which 39 papers were analyzed. The review results were discussed and voted in 2 consensus meetings of the WFNS (World Federation of Neurosurgical Societies) Spine Committee. Out of 39 studies, 15 studies have focused on thoracolumbar trauma, remaining 24 studies have looked at all spine trauma. Most were retrospective in nature; few were prospective and multicenter. Some studies have focused on specific injuries. The annual incidence of TL fractures is about 30/100,000 inhabitants including osteoporotic fractures. There is a trend to increase the fractures in elderly population especially in developed countries, while an increase of motor vehicle accidents in developing countries. The mortality rate among male elderly patients is relatively high. The incidence of thoracolumbar spine fractures is increasing because of low-velocity falls in the elderly population. The main reasons are falls and traffic accidents. Learning the regional differences and some special forms of trauma such as extreme sports, war, and gunshot injuries will help the prevention of the thoracolumbar spine fractures.

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