Abstract
Dismounted complex blast injury (DCBI) has been one of the most severe forms of trauma sustained in recent conflicts. This injury has been partially attributed to limb flail; however, the full causative mechanism has not yet been fully determined. Soil ejecta has been hypothesized as a significant contributor to the injury but remains untested. In this study, a small-animal model of gas-gun mediated high velocity sand blast was used to investigate this mechanism. The results demonstrated a correlation between increasing sand blast velocity and injury patterns of worsening severity across the trauma range. This study is the first to replicate high velocity sand blast and the first model to reproduce the pattern of injury seen in DCBI. These findings are consistent with clinical and battlefield data. They represent a significant change in the understanding of blast injury, producing a new mechanistic theory of traumatic amputation. This mechanism of traumatic amputation is shown to be high velocity sand blast causing the initial tissue disruption, with the following blast wind and resultant limb flail completing the amputation. These findings implicate high velocity sand blast, in addition to limb flail, as a critical mechanism of injury in the dismounted blast casualty.
Highlights
Blast injury was the leading mechanism of wounding and death in recent military conflicts, and its incidence in the civilian setting has increased steadily over the last 40 years (Mcfate and Moreno, 2005; Edwards et al, 2016)
We hypothesized that high velocity sand blast causes extensive soft tissue and skeletal disruption and plays an essential role in the injury pattern seen in Dismounted complex blast injury (DCBI)
We propose the following novel mechanism of injury causing traumatic amputation in the dismounted casualty: an initial secondary blast injury causes disruption to the soft tissues of the limb, with or without skeletal disruption, following which the blast wind and resultant limb flail complete the traumatic amputation at the level of the disruption (Figures 6A–D)
Summary
Blast injury was the leading mechanism of wounding and death in recent military conflicts, and its incidence in the civilian setting has increased steadily over the last 40 years (Mcfate and Moreno, 2005; Edwards et al, 2016). Improvised explosive devices have risen as the weapon of choice for inflicting blast injury, consisting of roadside explosives and mines, explosive formed projectiles, and suicide bombings (Ramasamy et al, 2009). These principally result in extremity wounding, for which the burden of injury can be substantial (Griffiths and Clasper, 2006; Owens et al, 2007). Post-mortem CT data have shown unstable pelvic fractures with lateral displacement of the sacroiliac joints to be the greatest predictor of vascular injury (Rankin et al, 2020).
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