Abstract
Pelvic vascular injury in the casualty of an explosive insult is a principal risk factor for increased mortality. The mechanism of injury has not previously been investigated in a physical model. In this study, a small-animal model of pelvic blast injury with a shock-tube mediated blast wave was utilised and showed that lower limb flail is necessary for an unstable pelvic fracture with vascular injury to occur. One hundred and seventy-three cadaveric mice underwent shock-tube blast testing and subsequent injury analysis. Increasingly displaced pelvic fractures and an increase in the incidence of pelvic vascular injury were seen with increasing lower limb flail; the 50% risk of vascular injury was 66° of lower limb flail out from the midline (95% confidence intervals 59°–75°). Pre-blast surgical amputation at the hip or knee showed the thigh was essential to result in pelvic displacement whilst the leg was not. These findings, corroborated by clinical data, bring a paradigm shift in our understanding of the mechanism of blast injury. Restriction of lower limb flail in the human, through personal protective equipment, has the potential to mitigate the effects of pelvic blast injury.
Highlights
The rise of the improvised explosive device as the weapon of choice in recent conflicts has changed the nature of injuries from gunshot wounds to the extensive tissue loss associated with blast injury.[21]
The original theory described the blast wave coupling with long bones, causing diaphyseal fracture through axial and shear stresses, followed by the limb flailing from the blast wind to complete the traumatic amputation at the level of the fracture.[7]
It is the first study to investigate a physical model of dismounted pelvic blast injury
Summary
The rise of the improvised explosive device as the weapon of choice in recent conflicts has changed the nature of injuries from gunshot wounds to the extensive tissue loss associated with blast injury.[21]. Lower limb flail has been hypothesised as the mechanism of injury in blast-mediated traumatic amputation. More recent data has suggested lower-extremity flail in isolation as a valid traumatic amputation mechanism, to account for the higher rate of through joint traumatic amputations seen compared to historic data (24.1 vs 1.3%) and the lack of a link between primary blast lung injury and traumatic amputation, as had previously been observed.[23]. The significant correlation between traumatic amputation and dismounted pelvic blast injury suggests they may share the same mechanism of injury. This mechanism of injury has not previously been investigated in a dismounted pelvic blast physical model
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