A review of casualties during the Iraqi insurgency 2006--a British field hospital experience.

BACKGROUND: 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. METHOD: Data was collected on all casualties of HA who presented to the British Military Field Hospital Shaibah (BMFHS) between January and October 2006. The mechanism of injury, anatomical distribution, ICD-9 diagnosis and initial discharge information was recorded for each patient in a trauma database. RESULTS: There were 104 HA casualties during the study period. 18 were killed in action (KIA, 21%). Of the remaining 86 surviving casualties, a further three died of their wounds (DOW, 3.5%). The mean number of diagnoses per survivor was 2.70, and the mean number of anatomical regions injured was 2.38. Wounds to the extremities accounted for 67.8% of all injuries, a percentage consistent with battlefield injuries sustained since World War II. Open wounds and fractures were the most common diagnosis (73.8%) amongst survivors of HA. Improvised explosive devices (IEDs) accounted for the most common cause of injury amongst casualties (54%). CONCLUSIONS: Injuries in conflict produce a pattern of injury that is not seen in routine UK surgical practice. In an era of increasing surgical sub-specialisation, the deployed surgeon needs to acquire and maintain a wide range of skills from a variety of surgical specialties. IEDs have become the modus operandi for terrorists. In the current global security situation, these tactics can be equally employed against civilian targets. Therefore, knowledge and training in the management of these injuries is relevant to both military and civilian surgeons.

Peri-acetabular external fixation for hip disease: an anatomical study.

Hip distraction using cross joint articulated external fixation has been used by a number of orthopaedic centres for the treatment of osteoarthritis, chrondrolysis, and osteonecrosis, as an alternative to hip arthroplasty or arthrodesis in the adolescent and young adults . The hip, however, is problematic with respect to external fixation, as it lies deep, surrounded by powerful muscles and in intimate contact with major neurovascular structures and intrapelvic organs. The numbers of patients treated by this technique to date remains small and the technical detail and potential complications, with respect to the application of the external fixation, unclear. In this study we used anatomical information from CT scans combined with computer modelling of the hip and pelvis to identify safe screw positions in the periacetabular region. The surgical insertion of the pins was then performed on five cadavers and anatomical dissections undertaken to confirm the structures at risk. This study indicated that whilst there are a number of anatomic constraints, it is still possible to insert three pins with good divergence into the limited bony corridor of the peri-acetabular region recognising that the more posterior of the laterally inserted pins poses a potential risk to the sciatic nerve if not inclined away from the sciatic notch.