Arul Ramasamy

Arul Ramasamy
Imperial College London | Imperial · Department of Bioengineering

MA PhD FRCS(Tr+Orth) FFSEM

About

81
Publications
29,812
Reads
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1,757
Citations
Introduction
I read Medicine at Trinity Hall, University of Cambridge, and graduated in 2000. I completed my basic surgical training in Newcastle, before transferring to Birmingham to commence Higher Surgical Training in Trauma and Orthopaedics. I joined Imperial College London for a PhD in biomechanics in 2009 and successfully completed my PhD in 2012. My thesis was related to lower limb blast injuries from under vehicle explosions.
Additional affiliations
January 2012 - present
The Queen Elizabeth Hospital
February 2011 - present
The Royal Orthopaedic Hospital NHS Foundation Trust
Position
  • Specialist Registrar
January 2010 - present
Imperial College London
Education
February 2015 - April 2015
Royal College of Surgeons of England
Field of study
  • Orthopaedic Surgery
October 2010
Society of Apothecaries
Field of study
  • Catastrophe and Disaster Medicine
October 2010 - October 2012
University of Birmingham
Field of study
  • Medical Education

Publications

Publications (81)
Article
Full-text available
Current military conflicts are characterized by the use of the improvised explosive device. Improvements in personal protection, medical care, and evacuation logistics have resulted in increasing numbers of casualties surviving with complex musculoskeletal injuries, often leading to life-long disability. Thus, there exists an urgent requirement to...
Article
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Improvements in protection and medical treatments have resulted in increasing numbers of modern-warfare casualties surviving with complex lower-extremity injuries. To our knowledge, there has been no prior analysis of foot and ankle blast injuries as a result of improvised explosive devices (IEDs). The aims of this study were to report the pattern...
Article
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The open blast fracture of the pelvis is considered to be the most severe injury within the spectrum of battlefield trauma. We report our experience of 29 consecutive patients who had sustained this injury in Afghanistan between 2008 and 2010. Their median new injury severity score (NISS) was 41 (8 to 75), and mean blood requirement in the first 24...
Article
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The outcomes of 261 nerve injuries in 100 patients were graded good in 173 cases (66%), fair in 70 (26.8%) and poor in 18 (6.9%) at the final review (median 28.4 months (1.3 to 64.2)). The initial grades for the 42 sutures and graft were 11 good, 14 fair and 17 poor. After subsequent revision repairs in seven, neurolyses in 11 and free vascularised...
Article
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The conflicts in Iraq and Afghanistan have been epitomized by the insurgents' use of the improvised explosive device against vehicle-borne security forces. These weapons, capable of causing multiple severely injured casualties in a single incident, pose the most prevalent single threat to Coalition troops operating in the region. Improvements in pe...
Article
Terrorist events in the form of explosive devices have occurred and remain a threat currently to the population and the infrastructure of many nations worldwide. Injuries occur from a combination of a blast wave, energised fragments, blunt trauma and burns. The relative preponderance of each injury mechanism is dependent on the type of device, dist...
Chapter
Although the vast majority of patients with an acute ankle sprain can be appropriately managed with non-operative functional treatment, the management of the athletic patient requires a more bespoke treatment approach. Within this high functioning group, acute surgical repair performed in an experienced high volume center, combined with a supervise...
Article
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The management of symptomatic osteochondral lesions of the talus (OLTs) can be challenging. The number of ways of treating these lesions has increased considerably during the last decade, with published studies often providing conflicting, low-level evidence. This paper aims to present an up-to-date concise overview of the best evidence for the sur...
Article
Developments in military personal armour have aimed to achieve a balance between anatomical coverage, protection and mobility. When death is likely to occur within 60 min of injury to anatomical structures without damage control surgery, then these anatomical structures are defined as ’essential’. However, the medical terminology used to describe c...
Article
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Penetrating injuries are commonly inflicted in attacks with explosive devices. The extremities, and especially the leg, are the most commonly affected body areas, presenting high risk of infection, slow recovery, and threat of amputation. The aim of this study was to quantify the risk of fracture to the anteromedial, posterior, and lateral aspects...
Article
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Bone is one of the most highly adaptive tissues in the body, possessing the capability to alter its morphology and function in response to stimuli in its surrounding environment. The ability of bone to sense and convert external mechanical stimuli into a biochemical response, which ultimately alters the phenotype and function of the cell, is descri...
Article
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Introduction Fractures have been a common denominator of the injury patterns observed over the past century of warfare. The fractures typified by the blast and ballistic injuries of war lead to high rates of bone loss, soft tissue injury and infection, greatly increasing the likelihood of non-union. Despite this, no reliable treatment strategy for...
Article
Aims: The aim of the study is to evaluate the clinical outcome and complications from the initial cohort of blast injured bilateral lower limb, above knee amputees who underwent Direct Skeletal Fixation (DSF). Patients and methods: We undertook a retrospective analysis of a prospective data base identifying patients who had undergone implantatio...
Article
Penetrating injuries due to fragments energised by an explosive event are life threatening and are associated with poor clinical and functional outcomes. The tibia is the long bone most affected in survivors of explosive events, yet the risk of penetrating injury to it has not been quantified. In this study, an injury-risk assessment of penetrating...
Article
Background Autologous osteochondral transplantation (AOT) has been shown to be a viable treatment option for large osteochondral lesions of the talus. However, there are limited data regarding the management of large lesions in an athletic population, notably with regard to return to sport. Our investigation focused on assessing both qualitative an...
Article
There are many bracing options for patients with functional limitations of the lower extremity following trauma. The first question that the provider must ask when evaluating a patient with a foot and ankle functional limitation because of weakness or pain is, "what are the patient's expectations?" One option for the patient who desires to return t...
Article
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Over 80% of wounded Service Members sustain at least one extremity injury. The ‘deck-slap’ foot, a product of the vehicle’s floor rising rapidly when attacked by a mine to injure the limb, has been a signature injury in recent conflicts. Given the frequency and severity of these combat-related extremity injuries, they require the greatest utilisati...
Article
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Aims: There has been an evolution recently in the management of unstable fractures of the ankle with a trend towards direct fixation of a posterior malleolar fragment. Within these fractures, Haraguchi type 2 fractures extend medially and often cannot be fixed using a standard posterolateral approach. Our aim was to describe the posteromedial appr...
Chapter
Energised fragments represent a heterogenous range of ballistic projectiles which are produced by an explosive event. Such encounters can occur in both the civilian environment due to terrorism as well as on the battlefield. In current conflicts fragmentation wounds have outnumbered those caused by bullets, with the UK and US experiences in Iraq an...
Article
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Introduction Malignant osseous foot tumours are uncommon. Their oncological outcomes have been poorly documented in the literature so far. The aim of this study was to establish the incidence and to evaluate the oncological outcomes of such patients. Methods Our large orthopaedic oncology database was used to review 70 malignant osseous foot tumou...
Chapter
Modern military conflict has been characterised by the insurgents’ use of anti-vehicle (AV) mines and Improvised Explosive Devices (IEDs). Frequently directed against vehicle borne troops, these devices, once detonated, transmit vast amounts of energy through the vehicle to the occupants. This leads to severe lower limbs injuries that are very ofte...
Article
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Objective: Review the outcome of patients with complex fractures around the knee treated with megaprosthesis. Method: Retrospective observational study of 10 patients was undertaken. Results: Six patients were treated with a distal femoral endoprosthesis (DEFPR) and four with an augmented rotating hinge knee replacement (RHK). The mean post-op...
Article
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The First World War (1914-1918) was the first truly industrial conflict in human history. Never before had rifle fire and artillery barrage been employed on a global scale. It was a conflict that over 4 years would leave over 750 000 British troops dead with a further 1.6 million injured, the majority with orthopaedic injuries. Against this backdro...
Article
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Background: The patterns and mechanisms of injuries of all Dutch battle casualties (BCs) were analyzed to improve the care for injured service members. We performed an in-depth analysis of all Dutch BCs during the participation of The Netherlands as lead nation in the International Security Assistance Force mission in southern Afghanistan. Method...
Article
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Introduction: Pedal acrometastases are a rare complication of disseminated malignancy. To date, there is little in the literature documenting their clinical course. Methods: Our large orthopaedic oncology database was used to review the clinical course of symptomatic pedal acrometastases. Results: A total of 15 cases of pedal acrometastases we...
Article
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Background: To improve care for battle casualties, we analyzed the surgical workload during the Dutch deployment to Uruzgan, Afghanistan. This surgical workload was compared with the resident surgical training and the pre-deployment medical specialist program. Methods: Patient data from the trauma registry (2006-2010) at the Dutch Role 2 Medical...
Article
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We identified thirteen patients with desmoplastic fibroma of bone treated at our institute over a 30 year period. The patients had a mean age of 25.9 years; eight were female. The incidence of desmoplastic fibroma of bone in all patients with benign bone tumours in our population is 0.003%. Surgical treatment ranged from primary amputation to intra...
Article
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Background Fractures of the distal radius are common, with volar locking plates being increasingly used in their treatment. They aim to provide stable internal fixation and are designed to mirror the natural anatomy. Current volar plate designs incorporate a volar cortical angle (VCA) of 25 degrees. Hypothesis The aim of this study is to determine...
Article
Full-text available
Fractures of the distal radius are common, with volar locking plates being increasingly used in their treatment. They aim to provide stable internal fixation and are designed to mirror the natural anatomy. Current volar plate designs incorporate a volar cortical angle (VCA) of 25 degrees. The aim of this study is to determine whether the VCA in uni...
Article
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The management of spinal deformity in children with univentricular cardiac pathology poses significant challenges to the surgical and anaesthetic teams. To date, only posterior instrumented fusion techniques have been used in these children and these are associated with a high rate of complications. We reviewed our experience of both growing rod in...
Article
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A key weapon in the insurgents' armamentarium against coalition and local security forces in Iraq and Afghanistan has been the use of anti-vehicle mines and improvised explosive devices (IEDs). Often directed against vehicle-borne troops, these devices, once detonated, transfer considerable amounts of energy through the vehicle to the occupants. Th...
Article
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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 bl...
Article
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Traumatic amputations remain one of the most emotionally disturbing wounds of conflict, as demonstrated by their frequent use in films to illustrate the horrors of war. Unfortunately, they remain common injuries, particularly following explosions, and, in addition, many survivors require primary amputation for unsalvageable injuries or to save thei...
Article
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Major pelvic ring fracture (PRF) due to blunt trauma results in lower urinary tract injury (LUTI) in up to 10% of cases. Significant comorbidity may result and this is particularly the case for unrecognised injury. The increase in military injuries due to improvised explosive devices in recent conflicts has revealed a complex injury cohort. The inc...
Article
Explosive weapons remain the leading cause of death, injury, and disability to combatants in battle. Recent conflicts in Iraq and Afghanistan have seen considerable advances in the surgical knowledge and skills needed to save life and limb of multiply injured casualties. Global terrorism has seen explosive weapons move from battlefield to urban cen...
Article
Objectives: Due to the absence of clinical blast data, automotive injury data using the abbreviated injury score (AIS) has been extrapolated to define current North Atlantic Treaty Organisation (NATO) injury thresholds for anti-vehicle mine tests. We hypothesized that AIS, being a marker of fatality rather than disability, would be a worse predict...
Article
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We describe 261 peripheral nerve injuries sustained in war by 100 consecutive service men and women injured in Iraq and Afghanistan. Their mean age was 26.5 years (18.1 to 42.6), the median interval between injury and first review was 4.2 months (mean 8.4 months (0.36 to 48.49)) and median follow-up was 28.4 months (mean 20.5 months (1.3 to 64.2))....
Article
Full-text available
The types of explosive devices used in warfare and the pattern of war wounds have changed in recent years. There has, for instance, been a considerable increase in high amputation of the lower limb and unsalvageable leg injuries combined with pelvic trauma. The conflicts in Iraq and Afghanistan prompted the Department of Military Surgery and Trauma...
Article
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Lower extremities are particularly susceptible to injury in an under-vehicle explosion. Operational fitness of military vehicles is assessed through anthropometric test devices (ATDs) in full-scale blast tests. The aim of this study was to compare the response between the Hybrid-III ATD, the MiL-Lx ATD and cadavers in our traumatic injury simulator...
Article
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The lower limb of military vehicle occupants has been the most injured body part due to undervehicle explosions in recent conflicts. Understanding the injury mechanism and causality of injury severity could aid in developing better protection. Therefore, we tested 4 different occupant postures (seated, brace, standing, standing with knee locked in...
Article
Anti-vehicle (AV) mines have been laid indiscriminately in conflict areas for the past 100 years. With an indeterminate life-span they continue to pose a significant threat to the civilian population, as well as restrict the movement of people, aid and goods to vulnerable populations. The aim of this study was to analyse unique casualty data from 2...
Article
Anti-vehicle mines and improvised explosive devices remain the most prevalent threat to coalition troops operating in Iraq and Afghanistan. Detonation of these devices causes rapid deflection of the vehicle floor resulting in severe injuries to calcaneus. Anecdotally referred to as a "deck-slap" injury, there have been no studies evaluating the pat...
Article
Blast injuries arising from improvised explosive devices are often complex leading to long-term disability in survivors. There is an urgent need to mitigate against the effects of blast that lead to these injuries, and to also improve post-traumatic therapeutic treatments related to problems associated with damage and healing processes and infectio...
Article
UK military forces have been deployed in Afghanistan since 2006 as part of the International Stabilisation Assistance Force. The Operation is supported by a 50-bedded hospital. In 2007 the Defence Medical Services introduced a massive haemorrhage policy. In asymmetric warfare gunshot wounds (GSW), improvised explosive devices (IED) and mine injurie...
Article
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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 i...
Article
British military forces remain heavily committed on combat operations overseas. UK military operations in Afghanistan (Operation HERRICK) are currently supported by a surgical facility at Camp Bastion, in Helmand Province, in the south of the country. There have been no large published series of surgical workload on Operation HERRICK. The aim of th...
Article
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Since World War II, more vehicles have been lost to land mines than all other threats combined. Anti-vehicular (AV) mines are capable of disabling a heavy vehicle, or completely destroying a lighter vehicle. The most common form of AV mine is the blast mine, which uses a large amount of explosive to directly damage the target. In a conventional mil...
Article
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The improvised explosive device (IED), in all its forms, has become the most significant threat to troops operating in Afghanistan and Iraq. These devices range from rudimentary home made explosives to sophisticated weapon systems containing high-grade explosives. Within this broad definition they may be classified as roadside explosives and blast...
Article
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Since the invasion of Iraq in 2003, the conflict has evolved from asymmetric warfare to a counter-insurgency operation. This study investigates the pattern of wounding and types of injuries seen in casualties of hostile action presenting to a British military field hospital during the present conflict. Data were prospectively collected on 100 conse...
Article
Background: Current ATLS protocols dictate that spinal precautions should be in place when a casualty has sustained trauma from a significant mechanism of injury likely to damage the cervical spine. In hostile environments, the application of these precautions can place pre-hospital medical teams at considerable personal risk. It may also prevent...
Article
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In the UK, general surgical specialist trainees have limited exposure to general surgical trauma. Previous work has shown that trainees are involved in only two blunt and one penetrating trauma laparotomies per annum. During their training, nearly half of trainees will not be involved in the surgical management of liver injury, 20% will not underta...
Article
Following the invasion of Iraq in April 2003, British and coalition forces have been conducting counter-insurgency operations in the country. As this conflict has evolved from asymmetric warfare, the mechanism and spectrum of injury sustained through hostile action (HA) was investigated. Data was collected on all casualties of HA who presented to t...
Article
The extremities remain the most common sites of wounding in conflict, are associated with a significant incidence of vascular trauma, and have a high complication rate (infection, secondary amputation, and graft thrombosis). The purpose of this study was to study the complication rate after extremity vascular injury. In particular, the aim was to a...