Landmine Explosions Research Articles

Krig er alvor - sårede og falne norske soldater i Afghanistan

Norway has been contributing military forces to Afghanistan since 2001. The following is an overview of all combat-related injuries and deaths among Norwegian soldiers in the period from 2002 to 2010. All medical records for Norwegian military personnel in Afghanistan in the period to January 2011 were reviewed and those who fell or were injured during combat were identified. The mechanism and anatomical region of the injury were registered and an injury severity score (ISS), revised trauma score (RTS) and probability of survival score were calculated. Deaths were classified according to military trauma terminology and were additionally assessed as either "non-survivable" or "potentially survivable". There were 45 injury incidents with nine deaths among 42 soldiers. The injury mechanism behind seven of the deaths was an improvised explosive device (IED). All injuries resulting in deaths were "non-survivable". Seven soldiers were severely injured. The mechanisms were bullet wounds, IED, splinters from grenades and landmine explosions. Twenty nine incidents involving 28 soldiers resulted in minor injuries. The most frequent mechanism was ricochet or splinter injury from shooting or an exploding grenade. The majority of conflict-related injuries in Afghanistan were due to explosions. The mechanism and anatomical distribution of the injuries was the same among Norwegian soldiers as among allies. The deaths were due to extensive injuries that were non-survivable.

Management of head trauma due to landmine explosions: From battle field to operation room

Background. Head injuries due to landmine explosions are not well studied and the management of such injuries is not documented, even though there is, unfortunately, a regrettably high incidence of such injuries in the military and in civilians. Methods. The data of 119 patients who underwent surgery for the head injuries due to landmine explosions were reviewed retrospectively. All of these patients were military personnel, and the mean age was 23 years. Results. A total 83 (69.7%) of the cases were injured by the anti-personnel devices and 36 (30.3%) by vehicle landmines. Fifty percent of the patients underwent surgery for depressed skull fracture, intraparenchymal foreign body, epidural haematoma or subdural haematoma. Six (0.05%) patients died in the emergency room. Conclusion. Landmine explosions can produce classic injury patterns from blunt and penetrating mechanisms to several organ systems, including the brain. They also produce unique injury patterns to the brain. Understanding this important difference is critical in management of these injuries. Early surgical treatment and appropriate management could save more lives.

ANALYSIS OF THREAT TO CREW POSED BY EXPLOSION OF CHARGE PLACED UNDER WHEELED ARMOURED VEHICLE

Provision of proper protection against landmines is a major aim of modern military vehicle designs. The point of developing the methods and means of countermine protection is to identify the shock wave impact on a vehicle construction and its crew. Information on overload coming from landmine explosions on a person are strictly confidential or not detailed enough. The basis to obtain them is to carry out experimental and numerical tests. This article presents basic issues and threats to crews as a result of landmine, IED or EFP explosions carried out by terrorists. The literature published has helped the authors to identify the main parts of body prone to the impulse load of a shock wave explosion on a wheeled military vehicle. The methodology and sample results of experimental tests identifying the shock wave load on a vehicle and its crew in a characteristic anthropometrics points of body are presented as well. Injury criteria and crew threat levels resulting from explosive load under a vehicle and its close area are outlined. The aim of such a complex analysis of shock wave load over wheeled military vehicles and their crews is the development of modern and effective protection devices.

Blast Injuries-and the Pivotal Role of Trauma Surgeons

An explosion is the sudden release of energy and its radial propagation through air, solid structures and living tissue. Treatment of blast injuries is complex and combines the principles of penetrating and blunt trauma, chemical or thermal burns and disaster and mass casualty management. Primary blast injuries are a direct result of the explosion itself. The sudden release of energy is translated into a shock wave that travels at supersonic speed (5000 metres/second). There is a sudden and short-lived rise in pressure, followed by a prolonged negative pressure, or vacuum, responsible for additional injury. The organs most at risk for primary blast injuries are the lungs, the ears and the gastrointestinal tract. The explosion also sets solid objects in motion; these act as projectiles, and can travel over far greater distances (secondary blast injuries), and their management is no different from penetrating or blunt trauma from other causes. The explosion may cause not only “projectiles,” but the body itself to be displaced: These tertiary blast injuries include traumatic amputations and crush injuries following land mine explosions. Finally, quaternary blast injuries comprise other forms of associated trauma, such as burns, asphyxia or poisoning from release of noxious substances by the blast. These injuries can be particularly taxing for rescue teams because of their tendency to affect large amounts of patients and the risk they pose to the rescuers themselves. Individual management of the blast injury victim requires a multidisciplinary team; terrorist or wartime bombings also require expertise in disaster management and triage.

A case of unusual cranial fracture due to land mine explosion

A case of unusual cranial fracture due to land mine explosion

Blast injuries of large tyres: Case series

Background Severe blast injuries of large tyres are similar to those resulting from landmine explosions with neither thermal nor chemical effects. Little has been written about the destructive nature of these blasts. Aims To evaluate our clinical management of patients involved in large tyre blasts. Patients and methods All patients who had tyre blast injuries and were admitted to Al-Ain or Tawam Hospitals between March 2003 and September 2009 were retrospectively studied. Clinical presentation, mechanism of injury, management, and outcome were reviewed. Results Seven male patients were studied. They had a median (range) age of 38 (20–53) years. Four patients (57%) were inflating the tyre when it suddenly exploded. On arrival to the hospital, two patients were unconscious with GCS of 3/15. Six patients (86%) had head/face trauma. Three patients had multiple injuries to different body parts (43%). The median (range) injury severity score was 14 (10–33). Four patients (57%) were operated on. Five patients were admitted to the ICU with a median (range) ICU stay of 2 (1–2) days. The median (range) total hospital stay was 3 (1–14) days. Two patients died (overall mortality 29%). Conclusions The high energy produced by large tyre blasts may cause severe injuries leading to high morbidity and mortality. Preventive occupational methods should be adopted and implemented at the work place.

Landmine associated injuries in children in Turkey

This study aims to examine trends of injuries due to landmines and unexploded ordnance (UXO) and to determine problems during and after the treatment of children and adolescent victims in Turkey. Data from the records of 23 children injured from landmines and UXO were analyzed from April 2001 to October 2008. Cases consist of 21 (91.3%) males and two (8.7%) females with a mean age of 12.8years. Cause of injury was landmine explosion in 20 (87.0%) and UXO in three (13.0%) cases. Injuries in upper and lower extremities were determined in eight (34.8%) children. Hand amputation was the result in 10 (43.5%) children where in two cases a leg, in one case an eye, in one case a hand and arm, in two cases a hand and leg, in one case an eye and a leg and in three cases a hand and eye were lost. One case of death was recorded from UXO with an autopsy performed. Contaminated areas in our region should be cleared according to international contracts to prevent injuries in children, centers providing rehabilitation services should be established and policies regarding social support for child victims should be ascertained.

Constitutive model for predicting dynamic interactions between soil ejecta and structural panels

A constitutive model is developed for the high-rate deformation of an aggregate comprising of mono-sized spherical particles with a view to developing an understanding of dynamic soil–structure interactions in landmine explosions. The constitutive model accounts for two regimes of behaviour. When the particle assembly is widely dispersed ( regime I), the contacts between particles are treated as collisions, analogous to those between molecules in a gas or liquid. At high packing densities ( regime II) the contacts are semi-permanent and consolidation is dominated by particle deformation and inter-particle friction. Regime I is modelled by extending an approach proposed by Bagnold (1954. Experiments on a gravity-free dispersion of large solid particles in a Newtonian fluid under shear. Proceedings of the Royal Society of London A 225, 49–63) to a general strain history comprising volumetric and deviatoric deformation. For regime II, classical soil mechanics models (such as Drucker–Prager) are employed. The overall model is employed to investigate the one-dimensional impact of sand against a rigid stationary target. The calculations illustrate that, unlike single-particle impact, the momentum transmitted to a rigid target is insensitive to the particle co-efficient of restitution, but strongly dependent on initial density. The constitutive model is also used to examine the spherical expansion of a shell of sand (both dry and water saturated). In line with initial experimental observations, the wet sand is predicted to form clumps while the dry sand fully disperses. The model shows that this clumping of explosively loaded wet sand exerts higher pressures on nearby targets compared to equivalent dry sand explosions.

Free-fillet flap harvested in ‘severe, high-energy landmine explosion’ injuries of lower extremity: A case report

Fillet flaps harvested from the non-replantable or unsalvageable amputated segment can be used to cover tissue defects. We discuss the case of a patient who had suffered a severe high-energy landmine injury, including severe leg damage, resulting in a below-knee amputation and soft-tissue defect around the forearm region. We successfully harvested the fillet from the amputated part of the extremity to the forearm region. We conclude that harvesting of a fillet flap from severely injured lower extremity, resulting from a high-energy landmine explosion, is technically feasible.

Burst fracture of the lumbar vertebra due to a landmine injury: a case report

IntroductionThe reason we report this case is that spine injuries may well occur due to landmines similar to other injuries like traumatic limb amputations and more over they may be overlooked.Case presentationThe patient was 29-years-old Turkish male and was a member of the military. He detonated the landmine that caused his injuries while in a conflict zone. He had a right below knee and left above knee traumatic amputations. He had also mild intermittent pain in his lower back. There were no focal neurological findings such as weakness, altered sensibility, or alteration in the function of the bowel or bladder. Radiographs of the lumbar spine revealed an L2 burst fracture. Computed tomography scans and magnetic resonance imaging of the lumbar spine demonstrated a burst fracture of the L2 vertebrae and moderate compression in the anterior portion of the thecal sac due to the fracture fragment. Because of the stabile nature of the L2 burst fracture and lack of neurological disturbance, operative decompression, instrumentation and fusion was not performed. After healing of the stumps, the patient was mobilized with immediate prostheses and a thoracolumbosacral brace.ConclusionSpine injuries should not be overlooked when evaluating patients after landmine explosions. After the patient has been stabilized, the secondary screening and radiographic evaluations should also comprise the thoracic, thoracolumbar and lumbar spine when treating patients after landmine injuries.

Validation of Lower Limb Surrogates as Injury Assessment Tools in Floor Impacts due to Anti-Vehicular Land Mines

The aim of this study was to assess the ability of lower limb surrogates to predict injury due to floor/foot plate impact in military vehicles during anti-vehicular land mine explosions. Testing was conducted using two loading conditions simulated to represent those conditions created in the field. The lower condition was represented by a 24-kg mass impactor with a velocity of 4.7 m/s. The higher loading condition was represented by a 37-kg mass impactor with a velocity of 8.3 m/s. Two biomechanical surrogates were evaluated using the loading conditions: 50th percentile Hybrid III foot/ankle and Test Device for Human Occupant Restraint THOR-Lx. Comparisons of the force-time response were made to established corridors. Results show a better correlation to the corridors with the THOR-Lx; however, future improvements to the THOR-Lx are recommended.

Stress and Birth Weight: Evidence from Terrorist Attacks

While terrorist attacks are relatively infrequent, Gary Becker and Yona Rubinstein (2008) provide evidence that they generate a disproportionate amount of stress and fear, suggesting that the indirect effects may be far more reaching than the direct effects. The international organization Medecins Sans Frontieres (2006) claims that the physiological effect of civil conflict is Colombian’s worst public health problem. This paper is the first attempt to measure the effect of prenatal psychological stress due to terrorism on child birth outcomes. The medical literature indicates that prenatal stress increases levels of CorticotrophinReleasing Hormone (CRH), which regulates the duration of pregnancy and fetal maturation and thus increases the risk of adverse birth outcomes (Pathik D. Wadhwa et al. 1993, among others). There is also evidence that birth outcomes are most sensitive to maternal stress in early stages of pregnancy (Laura M. Glynn et al. 2001). This study finds that the intensity of random landmine explosions during a woman’s first trimester of pregnancy has a significant negative impact on child birth weight. This finding persists when mother fixed effects are included, suggesting that neither observable nor unobservable characteristics of the mothers are driving the results. I use a large dataset, comprising approximately 4 million births in Colombia from 1998 to 2003, which enables me to observe multiple births by the same mother and gives strong statistical power to discern patterns. The data also allow me to link the date of a landmine explosion with the trimester of the pregnancy, and thereby to identify the stage of pregnancy Stress and Birth Weight: Evidence from Terrorist Attacks

Painful neuroma requiring surgical excision after lower limb amputation caused by landmine explosions

This article reports an analysis of 75 consecutive lower limb amputees who developed painful neuroma requiring surgical excision after lower limb amputation following landmine explosions. This retrospective study analyses the results of 75 patients who were treated for painful neuroma after lower limb amputation following landmine explosions between the years 2000 and 2006. The average time period from use of prosthesis to start of symptoms suggesting neuroma was 9.6 months. The average time period from start of pain symptoms to neuroma surgery was 7.8 months. All clinically proven neuromas were surgically resected. In the mean follow-up of 2.8 years, all patients were satisfied with the end results and all were free of any pain symptoms. Painful stump with clinical diagnostic findings of neuroma described above may be regarded as neuroma without requiring any further imaging modalities and is an indication for surgery if conservative measures fail.

Head injuries due to landmines

Landmine explosions cause most of the war injuries in the battlefield and pose a substantial public health risk. Although the lower limbs are usually affected, head injuries also occur. The aim of this study is to describe the types of head injuries caused by the explosion of landmines and the management of the victims. Fifteen patients who sustained a head injury due to a landmine explosion were treated in the Department of Neurosurgery between 2000 and 2006. The average age of the patients was 22.5 (range between 20 and 33). The Glasgow Coma Scale (GCS) score ranged between 3 and 15 and was 8 or less in 4. Shrapnel, stone and earth were the wounding agents. Four patients underwent neurosurgical treatment and 11, apart from simple scalp closure, had conservative treatment. Ten patients had associated lesions in the other parts of the body including thorax, upper and lower limbs, and the abdomen. Two patients died. At the time of admission, one had a GCS score of 3 and the other a score of 4. Infection was observed among 4 patients and a cerebrospinal fluid (CSF) fistula in 1 patient. Landmines occasionally cause head injuries. Surgical intervention is seldom required and survival is likely unless the patient is in deep coma. Multidisciplinary approaches are required in case there are associated lesions in the other parts of the body.

Injuries due to landmine blast referred to Shahid Motahhary hospital, Iran

Background: The health system faced a new problem of an increasing number of civilian victims of landmine explosions at the end of Iran-Iraq war. Methods: In a descriptive survey from 1998 to 2004, data was collected retrospectively from medical records of Shahid Motahhary Hospital, Urmia University of Medical Sciences, Iran. Result: The study covered 156 victims. 80% of the casualties were civilians of which 95% were male. Injuries led to amputation in 73.3% of the victims. The mortality rate was 3.8%. Blood transfusions was given to 93 (62%) victims. There were 52.6% pattern I, 14.6% pattern II and 32.6% pattern III injuries according to International Committee of the Red Cross (ICRC) classification. Conclusion: Mine awareness programs should be conducted amongst civilians who live in high-risk areas. Improved health infrastructure with trained personals for emergency care and early transfer of the casualties would reduce morbidity and mortality. Studies are required to understand the social and public health consequences of this problem.

Blindness and Eye Disease in Cambodia

Purpose: To assess the prevalence and etiology of blindness and low vision and to assess the prevalence of common eye diseases in central Cambodia. Methods: In this cross-sectional, population-based study, 6,558 residents of Kandal Province, Cambodia were registered, and 5,803 (88.5%) were interviewed and examined. This house-to-house survey was conducted by a team consisting of a senior ophthalmologist, a Cambodian eye doctor, and eight Cambodian eyecare workers. Results: The prevalence of bilateral blindness (visual acuity <3/60) is 1.1% (95% confidence interval [CI], 0.9–1.4), and an additional 4.4% (95% CI, 3.9–5.0) have low vision (visual acuity < 6/18, ≥3/60 in the better eye). The major causes of bilateral blindness are cataract (67.4%), phthisis (6.1%), uncorrected refractive error (6.1%), corneal scar (5.3%), uncorrected aphakia (3.0%), trachoma corneal scar (3.0%), optic atrophy (3.0%), and others (6.1%). The major causes of low vision are uncorrected refractive error (49.8%) and cataract (42.7%). The prevalence of unilateral blindness is 1.2% (95% CI, 0.9–1.4), often caused by cataract, corneal scar, or phthisis. Trauma due to landmine explosions and war-related injuries was frequently the underlying etiology in subjects with phthisis, corneal scarring, or other pathology.Conclusions: The prevalence of blindness and low vision in Cambodia is relatively high compared to other developing countries. Most of the causes of blindness and low vision are treatable or preventable. Landmines and other war-related injuries are an important cause of ocular injury. These results will assist in developing a national plan for the prevention of blindness in Cambodia.

Anti-personnel Landmine Injuries during Peace: Experience in a European Country

The purpose of this study is to report the incidence of landmine injuries during peacetime in a European country. Forty victims of landmine explosions were admitted to Didimoticho General Hospital in Greece, from December 1988 to March 2003. A total of 19 people survived (47.5%) these events; all of the others were dead upon admission to the hospital. All of the victims were men, either suspected smugglers or migrants entering the country illegally, with an average of 30 years (range: 15-56 years). Most victims presented in groups, with multiple traumatic injuries, including lower extremity wounds. The mortality rate in the minefield prior to hospital admission was 52.5%, and the amputation rate for the survivors was 37%. There were no deaths of the patients admitted to the hospital. Landmines cause high-energy injuries with high mortality and amputation rates. Illegal migrants are the main victims of landmine explosions in Greece.

Pitfalls in Reconstruction of Heel Defects due to Ground Landmine Explosions

Landmines are among the high-energy weapons that explode when a person steps on them and steps off. Ground landmine explosion results in severe complex soft tissue and bone defects, especially in the heel area. Such injuries bring a formidable challenge to both patients and reconstructive surgeons. The authors presented one of the largest series of patients with complex heel defects due to landmine explosion. They discussed their experience, as well as the pitfalls of reconstruction.

Timing of Microvascular Reconstruction of Landmine Injuries of the Lower Extremity

Landmine injuries of the lower extremity constitute a challenging problem for the reconstructive surgeon. These injuries create composite tissue defects which are always contaminated. The transfer of the patient to a well-established center generally takes time. All these factors yield a delay for definitive treatment of the patient. Here, the authorspresented 109 patients injured by landmine explosions and treated at different times and they discuss the effects of the timing of microvascular tissue transfer on the success of the procedure.

Evaluation of Late Functional Results of Patients Treated with Free Muscle Flaps for Heel Defects Caused by Land-Mine Explosions

High-energy land-mine explosions cause extensive soft-tissue and bone defects in the heel area, which mostly require free flap coverage. In this article, the authors present the long-term functional outcomes of 72 patients who had free muscle flap reconstructions for composite heel defects caused by land-mine explosions. The composite heel defects of 72 male patients caused by land-mine explosions were reconstructed by means of free muscle flaps. The mean follow-up was 6.5 years (range, 1 to 12 years). Each patient completed a questionnaire rating his level of satisfaction. Dynamic foot pressure distribution testing, three-dimensional motion analysis, and dynamic electromyography were performed for all patients. The data were compared with the control group of 20 volunteers. Statistical analysis was performed by Kruskal-Wallis, Mann-Whitney U, and Wilcoxon tests. Dynamic pressure distribution tests revealed significantly higher pressure and load in the injured feet of the patients (p < 0.05). Three-dimensional motion analysis showed restricted range of motion at the ankle joints of the injured extremity (p < 0.05). Seventeen patients were able to stand as long as the control group; the mean standing time for the others was 2.85 hours per day (range, 36 minutes to 5.32 hours). Many of the patients (71 percent) declared their satisfaction of having their own feet instead of prostheses. This is the longest series documenting the long-term functional results of patients injured by land mines who were treated with free muscle flaps. Reconstructive options should be preferred to amputation procedures in extensive tissue loss caused by land-mine explosion where possible.