Outcomes of IED foot and ankle blast injuries.

BACKGROUND: 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 of injury and determine which factors are associated with a poor clinical outcome. METHODS: U.K. service personnel who had sustained lower leg injuries following an under-vehicle explosion from January 2006 to December 2008 were identified with the use of a prospective trauma registry. Patient demographics, injury severity, the nature of the lower leg injury, and the type of clinical management were recorded. Clinical end points were determined by (1) the need for amputation and (2) ongoing clinical symptoms. RESULTS: Sixty-three U.K. service personnel (eighty-nine injured limbs) with lower leg injuries from an explosion were identified. Fifty-one percent of the casualties sustained multisegmental injuries to the foot and ankle. Twenty-six legs (29%) required amputation, with six of them amputated because of chronic pain eighteen months following injury. Regression analysis revealed that hindfoot injuries, open fractures, and vascular injuries were independent predictors of amputation. At the time of final follow-up, sixty-six (74%) of the injured limbs had persisting symptoms related to the injury, and only nine (14%) of the service members were fit to return to their preinjury duties. CONCLUSIONS: This study demonstrates that foot and ankle injuries from IEDs are associated with a high amputation rate and frequently with a poor clinical outcome. Although not life-threatening, they remain a source of long-term morbidity in an active population.

Evaluating the effect of vehicle modification in reducing injuries from landmine blasts. An analysis of 2212 incidents and its application for humanitarian purposes.

INTRODUCTION: 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 2212 mine incidents to determine if simple vehicle modifications can reduce fatality and injury rates from mine explosions. METHOD: We analysed casualty data from the Rhodesian War (1972-1980), to assess the effects of basic vehicle modifications (V-shaped hull, increased ground clearance, widened axles, heavy vehicles and blast deflectors) on injury rates. A multinomial regression statistical model was developed for vehicle modifications and number of alterations to explore these effects. RESULTS: Incident data was available on 2212 vehicle mine incidents involving 16,456 people. The overall fatality rate was 3.3% (544/16,456) and the overall injury rate was 22.7% (3741/16,456). Explosions against mine-protected vehicles resulted in a fatality rate of 1.2% (150/12,919); occupants in unprotected vehicles sustained a fatality rate of 11.4% (395/3537). The injury rate in mine protected vehicles was 22.2% (2868/12,919) compared to 24.7% in unprotected vehicles (873/3537). Utilising a multinomial logistical-regression model, we show that each design feature significantly reduced fatality rate (from 45% in unprotected vehicles to 0.8% in protected vehicles); each of these designs had a cumulative effect in fatality reduction. In isolation, blast deflectors, whilst reducing fatality rates, increased injury rates. CONCLUSIONS: Our data clearly demonstrates that simple vehicle modifications can have a significant effect on reducing fatality and injury rates from AV mine explosions. Given that the modifications described were produced using commercially available vehicles with basic engineering requirements, we believe that similar processes could be employed in post-conflict environments in a cost-effective manner.

The compressive behavior of the human glenoid labrum may explain the common patterns of SLAP lesions.

PURPOSE: The aim of the study was to define the normalized compressive stiffness (modulus) of the glenoid labrum around its circumference and to characterize the difference in modulus between different areas. METHODS: Sixteen fresh-frozen cadaveric shoulders were harvested and dissected down to the glenoid labrum. Any specimens with significant degenerative changes were discarded, leaving 8 labra for testing. The labrum was divided into 8 segments, to allow comparison around its circumference. A uniform testing specimen was produced from each area by use of a microtome. Each specimen measured 3 x 1 mm in cross section and was 6 mm in length. Indentation testing was conducted in a controlled environment of 100% humidity at 37 degrees C +/- 1 degrees C. RESULTS: We obtained 52 test samples from 8 labra. The mean modulus of the glenoid labrum was 69.7 megapascal (standard deviation, 36.2 megapascal). The anterosuperior portion of the labrum had a higher modulus than the posteroinferior portion (P = .0075). CONCLUSIONS: This study has shown that the human glenoid labrum's compressive behavior varies around its circumference. The greater modulus of the anterosuperior portion of the labrum supports the theory that this area is anatomically different from the rest of the labrum and resists compressive loads. CLINICAL RELEVANCE: These results may explain why the common type of SLAP lesions seen show failure at the interface between the labrum and the glenoid rather than within the substance of the labrum itself.

Comparison of 1- and 2-knot, 4-strand, double-modified kessler tendon repairs in a porcine model.

PURPOSE: To compare 1- and 2-knot, 4-strand, double-modified Kessler tendon repairs. It was our hypothesis that a 1-knot technique using an unbraided suture material would be stronger if it is possible for some movement to occur between strands on loading, redistributing forces such that the load is equally shared. METHODS: Fifty-six porcine flexor tendons were allocated to either a 1- or 2-knot, 4-strand, double-modified Kessler repair, and tested by incremental cyclical loading in vitro. RESULTS: The 1-knot technique was significantly stronger. Gap formation was initially greater in the 1-knot group, consistent with movement of strands, but with increasing physiological levels of applied force, there was no significant difference between the groups. CONCLUSIONS: The 1-knot technique was significantly stronger than the 2-knot technique.