Associated injuries in casualties with traumatic lower extremity amputations caused by improvised explosive devices

Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Edgbaston, Birmingham, UK.
British Journal of Surgery (Impact Factor: 5.21). 03/2012; 99(3):362-6. DOI: 10.1002/bjs.7765
Source: PubMed

ABSTRACT Improvised explosive devices (IEDs) pose a significant threat to military personnel, often resulting in lower extremity amputation and pelvic injury. Immediate management is haemorrhage control and debridement, which can involve lengthy surgery. Computed tomography is necessary to delineate the extent of the injury, but it is unclear whether to perform this during or after surgery.
The UK Joint Theatre Trauma Registry was searched to identify all UK service personnel who had a traumatic lower extremity amputation following IED injury between January 2007 and December 2010. Data were collected on injury pattern and survival.
There were 169 patients who sustained 278 traumatic lower extremity amputations: 69 were killed in action, 16 died from their wounds and 84 were wounded in action, but survived. The median (interquartile range) Injury Severity Score was 75 (21) for those killed in action, 46 (23) for those who died from wounds and 29 (12) for survivors. There were significantly more severe head, chest and abdominal injuries (defined as a body region Abbreviated Injury Scale score of 3 or more) in patients who were killed in action than in those reaching hospital (P < 0·001). Hindquarter amputations were the most lethal, with a mortality rate of 95 per cent. Of the 100 casualties who reached hospital alive, there were nine thoracotomies, one craniotomy and 34 laparotomies. All head or torso injuries that required immediate operation were clinically apparent on admission.
Higher levels of amputation were associated with greater injury burden and mortality. Intraoperative computed tomography had little value in identifying clinically significant covert injuries.


Available from: Mark Midwinter, Jan 27, 2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: A recent estimate of wounded from the Afghanistan war is close to 17,000 and from the Iraq war over 30,000. Extremity trauma is the one of the hallmark injuries from these conflicts. The long-term effects of this number of extremity-injured patients on our military and civilian health care systems is unknown. The relative severity, if amputation rate can be used as a surrogate, is significantly higher than in civilian trauma. In this article, we discuss the most current management strategies used in these complex patients and the myriad of lower extremity disease they experience. We also discuss a new “standard” for patients with severe lower extremity trauma. Previous expectations were to return patients to their preinjury level of function with limb retention. Now, the new expectation of this group of patients is to recover in a time frame and function level equivalent to a below knee amputee, which is a more accelerated course. Several advances have been made in an effort to offer similar functional results to these severely injured patients to include the gradual expansion muscle (GEM) flap, which corrects soft-tissue defects as well skeletal defects without the use of free-tissue transfer. Another significant advance is the Intrepid Dynamic Exoskeleton Orthosis (IDEO), which is a plantarflexion powered carbon fiber ankle-foot orthosis that allows patients with limb salvage the opportunity to return to high-impact activities. Other germane topics reviewed include management of calcaneal fractures with severe soft-tissue injury, partial foot amputations, and elective amputations for the indication of pain.
    Current Orthopaedic Practice 01/2013; 24(2):114-119. DOI:10.1097/BCO.0b013e318284ec40
  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this report was to analyse injury patterns and definitive management of local casualties with multiple blast extremity injuries in the Kabul International Airport Combat Support Hospital.
    International Orthopaedics 09/2014; DOI:10.1007/s00264-014-2532-6 · 2.02 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: While multiple studies have examined amputations that have occurred during the current conflicts in Iraq and Afghanistan, none of these studies have provided an overarching characterization of all of these injuries. METHODS: A retrospective study of all major extremity amputations sustained by US Service Members from January 2001 through July 30, 2011, was performed. Data obtained from these amputees included amputation level(s), mechanism of injury, time to amputation, Injury Severity Score (ISS), age, rank, number of trauma admissions, and number of troops deployed. RESULTS: There were 1,221 amputees who met inclusion criteria. These amputees sustained a total of 1,631 amputations. The number of amputations performed each year has increased dramatically in 2010 (196) and the first half of 2011 (160) from 2008 (105) and 2009 (94). The number of amputations performed per every 100 traumatic admissions (3.5-14) and the number of amputations per 100,000 deployed troops (2-14) has also increased in 2010 and the first half of 2011. Most amputations occurred at the transtibial (683, 41.8%) and transfemoral (564, 34.5%) levels. Thirty percent of the amputees (366) sustained multiple amputations, and 14% of all amputations (228) performed involved the upper extremity. There were 127 amputees (10%) who underwent their amputation more than 90 days after the date of injury. CONCLUSION: The number of amputations occurring during the current Iraqi and Afghanistan conflicts has increased in 2010 and the first half of 2011. Most amputations involve the lower extremities, and there is a much higher percentage of amputees who have sustained multiple amputations during current operations than previous conflicts. (J Trauma Acute Care Surg. 2012;73: S438-S444. Copyright (C) 2012 by Lippincott Williams & Wilkins)
    The Journal of trauma 12/2012; 73. DOI:10.1097/TA.0b013e318275469c · 2.96 Impact Factor