Purpose: A retrospective analysis was conducted of 82 orthopedic injury cases sustained by IDF military personnel during the recent low intensity conflict (the second Palestinian uprising) which is characterized by many casualties and high availability of medical services and evacuation means.

Methods: Records of all orthopaedic combat casualties evacuated to two level–I trauma centers between November 2002 and October 2005 were reviewed. Data included demographics, evacuation time, location of wounds, wounding agents, associated injuries, early/ late care and complications.

Results: There were 51 patients (62%) injured by fire-arms and 31 patients (38%) by fragments and explosives. Mean evacuation time was 60 (± 22) minutes. The spectrum of injuries included soft tissue injury −43 (52%), open fracture−40 (48%), neurologic injury-19 (23%), vascular injury-7 (8%) and amputation −1 (1%). The most common procedure was debridement and irrigation (D& I) which was performed on 70 patients (85%). 19% of the open fracture patients underwent primary internal fixation.

The mean length of hospitalization was 5 days (range 1–36). A multivariate statistical analysis was done, and it was found that being included in more than one category stands alone as the only predictor for prolonged hospitalization. Infection rate was 9.7%, with length of stay being the only parameter associated with infection.

Conclusion: The recent low intensity conflict is an excellent example of early and aggressive trauma care, with an increased use of primary internal fixation. There is a high incidence of open fractures (48% of all extremity injuries) and a low amputation rate (1%). Multiple operative procedures have been shown to be successful at limb salvage, but are time intensive.