Missile Injuries Research Articles

Missile Injuries to The Spine Local Experience and Review of The Literature

Introduction: Missile injuries of the spine particularly the high velocity projectiles are very destructive, leading to real disaster and even death. The incidence has increased recently on both civilian and military troops. The ideas behind writing this article is to shed the light on the seriousness of this type of injury and on the consensus for the ideal treatment depending on our local experience and others experience. Materials and Methods: We review our patient’s files whom had missile injuries related to orthopaedic practice since the last 40 years in public and private hospitals and we also search the web looking for articles discussing missile injuries in orthopaedic practice. We collect complications that observed in our patients and reported in literatures to be mentioned in the results of this review. Results: Missile injuries is the cause of 13-44% of all spinal injury. The cervical lesion is behind complete neurological deficit in 70% of cases. Almost all injuries are stable particularly in the cervical lesion provided that both facet and both pedicles remain intact. Probably pain is one of the commonest complications recorded. Bullets removed did not relieve the pain due to depression. Infection is very much expected after the dirty missile wounds. Neurogenic bladder and urinary tract infection are also possible, meningitis, bone infection, Charcot arthropathy and deformity are all possible. Lead intoxication is a late and very rare complication. The last rare but possible complication is the migration of the missile. Conclusions: Gunshot injury to the spine is becoming more and more prevalent in both military and civilian practice. Probably the absolute indication for surgery is the progressive neurological deficit. A cover of antibiotic is mandatory. A careful search for the instability is mandatory and lastly, Steroids use in spinal missile injuries is controversial.

Pattern and Management of Missile Injury to the Oral and Maxillofacial Region: A 12-Year Experience During Boko Haram Insurgency in Maiduguri, North-Eastern Nigeria.

Missile injury is a global public health problem, which occurs in both military and civilian settings. Boko Haram insurgency in North-Eastern Nigeria is one of the major violence the country experienced that resulted in many civilian casualties. This study was aimed at exploring the various patterns of the missile injuries to the maxillofacial region during Boko Haram insurgency. In this retrospective cross-sectional study, relevant information was retrieved from patient records including sociodemographic, causes of missile injuries, site of injuries, pattern of presentation, treatment, and the complications, and analysed using SPSS version 23. A total of 526 patients with various maxillofacial injuries were seen during this 12-year study period, with age ranging from 4 to 65 years, the peak incidence in the age group 31-40 years, 89.5% were males, 92.9% of the injuries were allegedly inflicted by insurgents and comprised of 61.0% gunshot injuries, 24.5% bomb blast, and machete cuts 7.4%. Most of the injuries occurred in the lower third of the face, 39.8%, and mandible was the commonest fractured facial bone. Facial injuries commonly are associated with devastating consequences to survivors and, hence, may require long time monitoring and psychosocial rehabilitations.

A predictive model of motor deficit in civilian ballistic lumbosacral spine injuries

BACKGROUND CONTEXTCivilian gunshot wounds to the spine are an increasingly common injury in the USA. A majority of the available research is focused on a military population suffering high energy missile injury. Minimal research has focused on civilian ballistic injuries to the lumbosacral spine as the available studies focus on the entire spine due to limited numbers. PURPOSECharacterize ballistic injuries to the lumbosacral spine and develop a model to predict the presence of neurological deficit based upon a patients presenting fracture morphology. STUDY DESIGNRetrospective chart review. PATIENT SAMPLEOne hundred forty-eight consecutive patients that were presented to an urban level 1 trauma center with ballistic injures to the spine involving the levels L1–S2. OUTCOMES MEASURESNeurological status at presentation and final follow up using the American Spinal Injury Association (ASIA) Impairment Scale. METHODSIRB approval was obtained, and retrospective chart review was performed. Extracted data included patient demographics, neurological status on presentation and final follow-up, fracture morphology, assessment of stability, other associated injuries, and surgical procedures performed. Proportional analysis was performed to characterize the fractures and their associated neurological injuries. Chi-square testing was done to identify fracture characteristics associated with neurologic injury. A multiple logistical regression was performed using fracture characteristics highly associated with neurological deficit to develop a model to predict neurologic deficit. The model was then validated with a receiver operator curve. RESULTSOf the 148 patients, 14 patients underwent spinal surgery with the most common indication being decompression and foreign body removal. There was a high incidence of intra-abdominal injury (73.6%). Fractures were characterized by level, affected vertebral component, and spinal canal involvement. Neurological injury was classified using the ASIA scale at presentation and final follow up. Odds-ratios of vertebral fracture characteristics showed neurologic deficit was highly associated with pedicle fractures (OR=9.07 [4.14–21.54] – 95% CI), lamina fractures (OR=6.42 [3.16–13.62] – 95% CI), facet fractures (OR=5.95 [2.90–12.79] – 95% CI), intra-canal bone (OR=12.79 [5.98–29.05] – 95% CI), and an intra-canal trajectory (OR=1078 [4.48–28.98]) – 95% CI. Multiple logistic regression was performed to construct a predictive model of neurologic deficit which showed that intra-canal trajectory, pedicle fracture and facet fracture are associated with neurologic deficit. An ROC curve was made with an area of 0.849 ([0.7853 to 0.9128 – 95% CI], p<.0001) demonstrating a good model fit. CONCLUSIONSBallistic injuries to the lumbosacral spine involve complex injury patterns in an often polytraumatized patient. Fractures involving the pedicle, lamina, and facet are highly associated with neurologic injury, as is a trans-canal trajectory. A patients fracture morphology can be used to predict if a neurologic deficit is present.

Incidence of Pencil and Pen Eye Injury among Children in Anambra State, South-East, Nigeria: Ten Year Retrospective Study

Background: Eye injuries constitute a significant portion of most ophthalmologic consultations and ocular emergencies with grave consequences, especially in children, if not managed well early enough. Traumatic eye damage is the leading cause of monocular blindness worldwide. This study aimed to determine the incidence, circumstances and types of ocular injury among children in Anambra state, South-East, Nigeria.&#x0D; Materials and Methods: A ten- year retrospective study of 211 children aged below 18 years who presented with eye trauma in two mission hospitals in Anambra State, Nigeria. Case file of children with ocular trauma were retrieved from the medical records and those with pencil and pen injury isolated. Required information was extracted from the case files and recorded in a pro-forma. The data was analyzed using Statistical Package for Social Science, Version 20 (SPSS-20).&#x0D; Results: The incidence of pencil/pen eye injury was 10.9% (23/211). The injuries were commoner in males (M:F=1.6:1) and in those aged five years and below. Stab injuries constituted 56.5% (13) of the injuries while 34.8% (8) were missile injuries. Forty-six percent (6) of the stab injuries were self-inflicted with two-third of this being in children younger than five years. Corneal laceration, followed by anterior uveitis, was the commonest form of eye injury.&#x0D; Conclusion: There is a high incidence of pencil and pen injury in South-East, Nigerian children. Although visual prognosis is good with early presentation and treatment, adequate preventive measures should be put in place to forestall the occurrence of this potentially blinding condition in children.

STATE OF CARDIOVASCULAR SYSTEM IN MILITARIES OF UKRAINE ARMED FORCES UNDER THE WAR WITH RUSSIA.

To study the state of cardiovascular system in servicemen (SM) of Ukraine Armed Forces (UAF), who took part in the fight against russian military aggression, and the factors of military service that could cause the occurrence of circulatory system diseases. The study included 110 men of UAF, who were undergoing examination and treatment at the NRCRM. The average age of the examinees was (46.4 ± 8.8) years. The checkup included an examination by a cardiologist and different diseases experts (as indicated), electrocardiography, Doppler echocardiography, daily monitoring of the electrocardiogram and other necessary studies. Hypertensive heart disease (HHD) was diagnosed in 83.6 % of patients, coronary heart disease (CHD) in 52.8 % ones, including 7.3 % of persons who survived an acute myocardial infarction, heart failure (HF) in 80.9 % of patients. Before the war, 51.8 and 7.3 % of SM suffered from HHD and CHD, respectively. Seven SM sustained a missile wound of extremities and subsequently developed HHD, suggesting a possible association between the two events (Pearson's χ2 = 4.148 with р = 0.042, but р = 0.081 using Fisher's exact test). Out of 18 SM without signs of HHD, 8 had normal body weight and 10 had obesity, when in SM with HHD it was 7 and 15 persons, respectively.Obesity I degree discovered in 10, and II degree in 2 SM. Excess body weight and the degree of obesity had a significant relationship with HHD development (χ2 = 8.995; р = 0.029). The age of patients with CHD (50 persons) was significantly greater than that of patients without CHD (52 persons): (50.1 ± 5.4) vs. (42.0 ± 9.5) years at р = 0.000. Among circulatory system diseases in SM of UAF HHD and CHD were the most common ones. More than half of the SM were sick with HHD before being drafted into the army. During the period of taking part in the war the development of HHD new cases was observed in 35 SM, and CHD in 50 SM. The onset of HHD new cases can be associated with missile wound of extremities and obesity, and new CНD cases with age factor.

P-015 POLY-4-HYDROXYBUTYRATE ABSORBABLE BARRIER COMPOSITE MESH AND POLY-PROLINE MESH: DUAL REPAIR FOR HUGE INCISIONAL HERNIA

Abstract Introduction A giant incisional hernia is a serious challenge. Along with loss of domain, the ideal surgical management is difficult to identify, with various surgical techniques and meshes. Obesity and comorbidities in patients with diabetes add to difficulties in repairing incisional hernias with loss of domain. Herein, we present a case in which a double-mesh technique was performed for surgical repair of huge incisional hernias. Presentation of Case An 80-year-old male patient with multiple comorbidities presented to the clinic with multiple incisional hernias secondary to a missile injury. The huge incisional hernias affected the patient's daily life and limited his activities. Abdominal computed tomography showed multiple central and lateral incisional hernias. Through a midline laparotomy, a 30 × 35-cm poly-4-hydroxybutyrate/absorbable barrier composite (P4HB/ABC) mesh was sutured to the abdominal wall intraperitoneally, and then a 20 × 25-cm lightweight polypropylene (LWPP) mesh was sutured to the edge of the muscular defect. Discussion This report described the case of a patient with multiple huge abdominal hernias, which were repaired using the double-mesh technique. The patient had an uneventful postoperative recovery. However, the patient had a seroma during follow-up, which was managed conservatively. Conclusion This report described the usefulness and challenges of using the double-mesh technique for successful repair of multiple central and lateral incisional hernias. We used two types of meshes, P4HB/ABC and LWPP meshes, which yielded good outcomes and no hernia recurrence occurred in a 3-year follow-up.

Defects of the sciatic nerve and its divisions treated by direct suturing in 90 degrees knee flexion: report on the first clinical series.

To evaluate functional results after treatment of large defects of the sciatic nerve and its divisions by direct nerve suturing in high knee flexion. A retrospective review was conducted in patients treated for lower extremity nerve defects between 2011 and 2019. Inclusion criteria were a defect > 2cm with a minimal follow-up period of 2years for the sciatic nerve and 1year for its divisions. Nerve defects were bridged by an end-to-end suture with the knee flexed at 90° for 6weeks. Functional results were assessed based on the Medical Research Council's grading system. Seventeen patients with a mean age of 27.6years were included. They presented with seven sciatic nerve defects and ten division defects, including eight missile injuries. The mean time to surgery was 12.3weeks and the mean nerve defect length was 5cm. Overall, 21 nerve sutures were performed, with eight in the tibial distribution and 13 in the fibular distribution. Post-operatively, there was no significant knee stiffness related to the immobilization. The mean follow-up time was 24.5months. Meaningful motor and sensory recovery were observed after 7 of 8 sutures in the tibial distribution and 11 of 13 sutures in the fibular distribution. A functional sural triceps muscle with protective sensibility of the sole was restored in all patients. There were no differences according to the injury mechanisms. Temporary knee flexion at 90° allows for direct coaptation of sciatic nerve defects up to 8cm, with promising results no matter the level or mechanism of injury.

Penetrating spinal cord injury: a systematic review and meta-analysis of clinical features and treatment outcomes.

To systematically review the literature on penetrating spinal cord injury (PSCI) and evaluate current management strategies, their impact on patient functional outcomes, and treatment complications. PubMed, Scopus, and Cochrane were searched based on the Preferred Reporting Items for Systematic-Reviews and Meta-Analyses (PRISMA) guidelines to include studies on penetrating spinal cord injury (PSCI). We included 10 articles comprising 1754 cases of PSCI. Mean age was 19.2 years (range, 16-70), and most patients were male (89.9%). Missile spinal cord injury (MSCI) was the most common type, affecting 1623 patients (92.6%), while non-missile spinal cord injury (NMSCI) accounted for only 131 cases (7.4%). Gunshots were the most common cause of MSCI, representing 87.2%, while knife stabs were the most common cause of NMSCI, representing 72.5%. A total of 425 patients (28.0%) underwent surgical intervention, and 1094 (72.0%) underwent conservative management. The conservative group had a higher rate of complete spine cord injury compared with the surgical group (61.5% vs. 49.2; p < 0.001). Although surgery yielded a higher score improvement rate compared with the conservative management (41.5% vs. 20.5%, p < 0.001), neither treatment strategy displayed superiority in improving neurological outcomes for neither complete SCIs (OR:0.7, 95% CI, 0.3-1.64; I2 = 44%, p = 0.13) nor for incomplete SCIs (OR:1.15, 95% CI, 0.64-2,06; I2 = 40%, p = 0.12). Surgical and conservative management strategies proved to be equally effective on PSCI, irrespective of injury severity. Therefore, tailored treatment strategies for each patient and careful surgical selection is advised.

Experimental Study of Action Different Kinetic Energy on the Colon

The purpose of the study. To increase the effectiveness of surgical care for the wounded with combat trauma of the colon by studying of ballistic, morphological and functional features of the gunshot wounds. Patients and methods. A study of surgical treatment of 83 wounded with combat injuries of the colon, received in the area of anti-terrorist operation in the period from 2014–2018. For comparative analysis of treatment results, two clinical groups were formed: comparison and main. The comparison group included 42 wounded who were treated from April 2014 to February 2015 (the first and second periods of ATO), who used traditional surgical tactics. The main group included 41 wounded who were treated from March 2015 to 2018. Results. Analysis of the distribution of wounded with combat trauma by type of wound / injury revealed that the vast majority of them in both groups had shrapnel wounds – 49 (59.1%). There were 30 (36.1%) victims with bullet wounds, and 4 (4.8%) with closed injuries. The wounded patients with the battle trauma of the thick bowel by type of injury had missile wounds as a rule – 49 (59.1%). There were 30 (36.1%) patients with bullet wounds, and 4 (4.8%) with closed injuries. Most of the injuries were combined – 58 (69.9%), and with only abdominal injuries – 25 (30.1%), mostly multiple – 21 (25.3%). The great majority of the thick bowel injuries belonged to sigmoid – 32 (38.6%) and transverse colon – 21 (25.3%), which is explained by relatively large size of these parts of the intestine. Conclusions. The choice of surgical tactics and scope of surgical interventions on damaged organs and structures took into account the results of experimental study of mechanogenesis and pathomorphology of gunshot wounds of the colon, obtained in bench studies by modeling gunshot wounds on “thoracoabdominal ballistic material”.

Spontaneous migration of retained intracranial missiles: experience with 16 cases.

Spontaneous migration of retained intracranial missiles is uncommon but a potentially serious phenomenon. Our objective is to increase awareness of the risk of spontaneous migration of retained intracranial missiles by reporting our case series of 16 patients. We performed a retrospective single-center study on patients treated for intracranial missile injuries between 2000 and 2010 in Palestine with a particular focus on the migration of retained intracranial missiles. Detailed analyses were made of patients' age, sex, type of injurious agents (metallic bullets/rubber bullets/metallic shrapnel from bomb explosion), initial missile position, site to where the missile migrated, radiological and neurological manifestations, complications, treatment modalities (surgery vs. conservative) and functional outcome by Glasgow outcome scale-extended (GOSE) classification at last follow-up. In a cohort of 190 patients with retained intracranial missiles, we identified 16 (8.4%) patients with spontaneous migration. Patients' age ranged from 10 to 30years (mean: 18.9 ± 6.4years). There were only 2 female patients. The missiles that migrated intracranially were metallic bullets (n = 10), rubber bullets (n = 3), and metallic shrapnel from a bomb explosion (n = 3). Among the 16 patients, 10 patients experienced symptoms due to missile migration and were treated surgically, while six patients did not develop new symptoms after missile migration and were managed conservatively. In our case series, 16/190 (8.4%) patients with retained intracranial missiles developed spontaneous migration. Neurosurgeons performing delayed surgery on patients with retained intracranial missiles should be aware of the risk of spontaneous migration and verify the location of the missile after positioning the patient for surgery.

Description of oral and maxillofacial ballistic missile injuries based on tactics and terrain of conflict in Yemen civil war: account from a level 1 trauma center in Najran, Saudi Arabia

article: Description of oral and maxillofacial ballistic missile injuries based on tactics and terrain of conflict in Yemen civil war: account from a level 1 trauma center in Najran, Saudi Arabia - European Journal of Oral and Maxillofacial Surgery 2022 April;6(1):17-23 - Minerva Medica - Journals

Peculiarities of treatment of patients with gunshot fractures of the leg in Yemen

Retrospective analysis of treatment of 232 wounded with gunshot crus fractures was presented. All patients were treated at Jemen Central Hospital ALTAWRA (Sana) from 1966 to 2000. Out of all patients 94% had missile wounds and 6%) comminuted wounds. All wounded were admitted to Hospital during 24 hours after injury. Peculiarities of wound treatment were the following: injured limb after application of author's stabilizing reposition device if necessary was washed by soap-saline solution. Primary debridement was more active compared to classic one and included removal of small osseous fragments and resection of large osseous fragment ends. In 66%) of wounded no complications were observed during postoperative period and healing by first intention was noted. In 8,4%) of patients healing by granulation occurred. In 15% of cases wound suppuration was limited by soft tissues. Osteomyelitis was diagnosed in 8,6% of patients. In 2% of cases crus gangrene followed by vascular thrombosis was developed.

Associated projectile inferior vena cava wound with subsequent pulmonary artery missile embolization: a case report and literature review

A rare and unpredictable complication of firearm and missile injuries is projectile embolism. With only a few cases described in the literature, bullet embolism may become a diagnostic challenge for emergency physicians and military surgeons. Bullet embolization is a rare phenomenon, but the complications can be devastating. Case presentation. A 34‑year‑old man sustained a severe complex abdominoskeletal mine‑blast injury with damage to the hollow organs (duodenum and transverse colon), inferior vena cava and both low extremities. The internal hemorrhage was stopped by phleborrhaphy. The wounds of the duodenum and large intestine were sutured, and gunshot fractures of both anticnemions were stabilized by extrafocal osteosynthesis. The whole‑body CT showed that there was a projectile embolus into the branch of the right mid‑lobe pulmonary artery. No clinical manifestations of pulmonary artery embolism were observed in the patient. After surgery, he developed multiple necrosis and transverse colon perforations that resulted in fecal peritonitis. The suture line leakage that caused the formation of a duodenal fistula and postoperative wound infection were also detected. The complications were managed by multiple reoperations. The attempts of endovascular bullet extraction weren’t undertaken due to severe concomitant injuries, complications and asymptomatic clinical course of pulmonary artery projectile embolism. Open surgery retrieval of the embolus was successfully performed on the 80th day after injury. The patient was discharged from the hospital in good condition on the 168th day after the missile wound. Conclusions. Patients with missile wounds and no exit gunshot perforation should be examined using the whole‑body CT for determining possible migration of a projectile with the blood flow. Patients with asymptomatic pulmonary artery embolism should be managed nonoperatively. In case of symptomatic pulmonary artery projectile embolism, it is reasonable to consider the possibility of open thoracic surgery.

Management of Missile Injuries of the Knee

Background and Objectives: Iraq continues to be a troublesome area, missile injuries around the large joints of the extremity remains to be a challenging injury to the under resourced and poorly equipped unsafe hospitals. The aim of this study is to report our experience in the management of such injuries. patients and methods: Thirteen patients (14 knees) with grade III Gustillo open fractures of the knee caused by war injury including bullets, shells of blast and missiles were treated by wound debridement, washout, repair of arterial injury after external or internal fixation of the fracture. Five patients (38%) required Dacron arterial graft for associated vascular injury, there was a case of permanent nerve damage (7%). Results: The outcome was satisfactory in 6 patients (46%), fair in five (38%) and poor in the remaining (16%). One limb remained was ischemic; one case of infection required amputation. These patients underwent wound debridement, skeletal fixation and vascular and or plastic reconstruction. Conclusion: There is high association of open war injuries of the knee with neurovascular injuries. Awareness of the associated vascular injury and team approach, is vital in the management of these injuries. Skeletal stabilization using any method deem to be appropriate is associated with good outcome provided appropriate early wound debridement is performed.

Craniocerebral missile injuries in a combat zone: spectrum of injuries and lessons learnt

BackgroundHigh-velocity missile injuries are commonly encountered in war or war-like situations. Aggressive resuscitation, early evacuation to neurosurgical center, and application of neurosurgical principles remain tenets of success. MethodsThe spectrum of injuries and clinical profile of 14 such cases with craniocerebral missile injuries managed at our center in the northern sector were included. Site of injury, GCS at presentation, associated injuries, surgical intervention, duration of hospitalization, and recovery of the patient were analyzed. ResultsFive patients had sustained gunshot wounds, and nine patients had sustained shrapnel injuries. Thirteen patients were deeply comatose, and one patient was conscious. The entry wound was in frontal lobe in eight patients, and in four patients, it was in the faciocranial area. Ten patients had Glasgow Coma Scale (GCS) less than 8 at presentation. Surgical intervention was required in 13 patients, including 11 decompressive craniectomies and anterior skull base repair in four patients with faciocranial entry wound. One patient expired during initial resuscitation, and one patient died in the postoperative period. Location of injury was the single most important determinant of outcome. ConclusionAn early decompressive craniectomy provides a reasonable chance of recovery. Aggressive debridement involving track explorations, lobectomies, or removal of retained shrapnels is not beneficial. Injuries to the skull base and violation of sinus spaces predispose these patients to cerebrospinal fluid leaks and infective sequelae. All these patients require aggressive postoperative intensive care and rehabilitation.

Management of Depressed Skull Fractures: Selective Conservative Management of Non Missile Injuries

Objective: To determine the outcomes of management of depressed skull fractures. Study Design: Descriptive Study Place and Duration of Study: Department of Neurosurgeries, Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences Gambat and Chandka Medical College Hospital, Larkana from 1st March 2020 to 28th February 2021. Methodology: Eighty patients of both sexes were enrolled in this study. Patients were aged between 12-70 years of age. Patient’s detailed demographics age, sex and body mass index were recorded. Diagnosis of skull fractures from closed head injury patients were undergone for CT scan Depressed fracture of more than 5 mm, cosmetically disfiguring fractures and fracture over the sinuses were operated. All the patients were given prophylactic antibiotics and anticonvulsants. Patients were followed for 4-months. Outcomes were assessed by Glasgow Coma Scale (GCS). Results: Fifty five (68.8%) patients were males and thirty five (31.2%) were females with mean age was 18.21±7.32 years and mean body mass index was 20.04±3.14 kg/m2. Road traffic accident (56.25%) was the most common cause of the injury followed by fall from the height 25 (31.25%). The compound fractures have 48 (60%) and simple fractures were 32 (40%). Surgery was done among 70 (87.5%) cases and 10 (12.5%) patients were conservatively treated. Among these 50 (62.5%) patients were completely recovered. Cerebrospinal fluid leak was the most common complication and was found in 13 (16.25%) cases. Conclusion: The use of antibiotics and anticonvulsants had effective results during peri-operative periods to avoid infection and epilepsy. The initial stage of operation is particularly necessary when the fracture is larger than 5mm. Cerebrospinal fluid leaks occur after surgery as the most common complication. Keywords: Depressed skull fracture, Non-missile injuries, Cerebrospinal fluid

Civilian Missile Injuries in Iraq after 2003, Misan as an Example

A retrospective study analyzing data of patients admitted because of missile injuries over more than onedecade in Misan, Iraq.4098 patients were involved in the study, 3550 patients sustained bullet injuries and 548patients sustained explosive injuries. Urban young male patients were mainly affected. Periods of politicalinstability and civilian unrest were associated with increasing numbers of affected patients especially theyears (2003-2007) and (2014-2015). Fatal injuries were due to bullet injuries rather than explosive injuries.In conclusions effective legislations regulating the use of weapon in the civilian life, political stability, andinternational supports are important factors that help the country to reduce the effect of this problem.

Surgical Outcome and Prognosis of Spinal Missile injuries

Surgical Outcome and Prognosis of Spinal Missile injuries

The changing paradigm of injuries and their outcome in an international conflict zone

Background: The characteristics of combat injuries differ from those encountered in civilian practice in terms of epidemiology, mechanism of wounding, pathophysiology, trajectory after injury and outcome. Furthermore, the nature of combat injuries is likely to change because of changes in the ways wars will be fought; such changes may influence therapeutic tactics and techniques, and military medical planning and logistics. Proper medical deployment at various peacekeeping missions requires projecting injuries. For this reason, the injury patterns and mechanism of injury were reviewed over a five year period, and injury rates and mechanisms were extracted for review. Methods: An observational study of 2942 trauma cases attending trauma Out Patient Department and emergency centre of United Nations Peacekeeping Mission Hospital in eastern DRC (Democratic Republic of Congo), was carried out from Jan 2009 to Dec 2013. The study includes age profile of patients along with the distribution and mechanism of injuries. Results: Penetrating injuries and blunt injuries accounted for 4.65% and 95.35% respectively of the total injuries sustained. The majority of the patients sustained injuries like mixed burns and inhalation injuries, assaults and contusions (84.33%). The most common age group affected was 22- 29 years (60.74%). Conclusions: The data clearly demonstrate that humanitarian and peacekeeping missions require preparation for a wide variety of mechanisms of injuries including non-combat trauma beyond the expected penetrating missile and blast injuries of a typical war scenario.

10.4314/ajns.v9i2.70402

Background The missile injuries of the cranium and brain in the modern era have shifted from soldiers to the civilians and from the battle grounds to the populated zones due to increase in the terrorist and military strikes. The management of the victims depends on the resuscitation at the site of injury and the distance and transportation to the tertiary care centre. This article presents the details of the missile injuries to the brain, the third-world problems and the management. Material and methods A retrospective analysis of 3794 craniocerebral missile injuries, managed by the Department of Neurosurgery at Sher-I-Kashmir Institute of Medical Sciences (SKIMS) Kashmir, India, over a period of more than 21 years from September 1988 to September 2009. Patients were triaged in emergency CT-room, resuscitated and operated. Statistical software programme SPSS 11.5 was used to derive the numerical significance. Results Revealed an overall mortality of 87.69% (3327 out of 3794). Most of the deaths 79.14% (2633 out of 3327) occurred within 30 minutes of the patient’s arrival to the hospital and only 694 patients lived beyond one hour of arrival. Conclusion Presently the quantum of outcome i.e, survival and good recovery in craniocerebral missile injuries appears a meager heap compared to the huge amount of death and disability. And the situation will continue to be so unless tertiary care hospitals are set up within and around the armed and conflict zones, war torn areas and battle fields, rather than risking transportation, time of resuscitation, intervention and the results. Key words: Craniocerebral, Kashmir, Missile Injuries, Outcome.