This work examines the Upper limb (UL) blast-mediated traumatic amputation (TA) significance from recent operations in Afghanistan. It is hypothesized that the presence of an UL amputation at any level is an independent predictor of torso injury. A joint theatre trauma registry search was performed to determine the number of British casualties with TA and their associated injuries. UL TA accounted for 15.7% of all amputations; distributed: shoulder disarticulation 2.5%, trans-humeral 30%, elbow disarticulation 10%, trans-radial 20% and hand 37.5%. The presence of an UL amputation was more likely in dismounted casualties (P=0.015) and is a predictor of an increased number of total body regions injured and thoracic injuries (P 0.001 and P 0.026 respectively). An increased Injury Severity Score (ISS) was seen in patients with multiple amputations involving the UL (UL TA present ISS=30, no UL TA ISS=21; P=0.000) and the ISS was not significantly different whether mounted or dismounted (P=0.806). The presence of an upper limb amputation at any level should insight in the receiving clinician a high index of suspicion of concomitant internal injury; especially thoracic injury. Therefore with regards to blast mediated TA the injury patterns observed reflect a primary and tertiary blast mechanism of injury.
The explosive device has successfully been used by terrorists globally, with their effects extending beyond the resulting injuries. Suicide bombings, in particular, are being increasingly deployed due to the devastating effect of a combination of, high lethality and target accuracy. This aim of this study was to analyse the demographics and casualty figures of terrorist bombings worldwide. Analysis of the Global Terrorism Database and a PubMed search (keywords “terrorist”, and/or “suicide”, and/or “bombing”) from 1970 to date was performed. Of 58,095 reported terrorist explosions worldwide, 5.08% were suicide bombings. Incidents per year is increasing (P<0.01). PubMed identified 41 publications reporting 167 incidents. Mean casualty statistics per incidents was 1.14 deaths and 3.45 wounded from non-suicide incidents, and 10.16 and 24.16 from suicide bombings (p<0.05). The Middle East witnessed the most incidents (26.9%), with Europe ranked 4th in the number of terrorist related explosion (13.2%). Differing injury patterns were seen in open, confined and building collapse incidents. Terrorist bombings continue to be a threat and are increasing in the Middle East and Europe. Suicide bombings are becoming an increased threat with greater casualty figures per incident seen. This data assists in the planning of security, logistics, casualty evacuation and care.
Military personnel operating on high speed marine craft are exposed to Whole-Body Vibration (WBV). Additionally planing craft operate at speeds with minimal contact of the hull with warer making the crew vulnerable to mechanical shock. An association between Low Back Pain (LBP) and exposure to WBV has been extensively reported in civilian literature. LBP is reported by military personnel operating on planing craft leading to downgrades and potential discharge. There is a clear need to understand the impact prolonged exposure has on our population operating these craft. We performed a bibliographical search of the PubMed database for records using a combination of keywords. Abstracts were screened for relevance and references cited in retrieved papers reviewed. There is no consensus in the literature on the potentially pivotal pathological process behind the association. Evidence from professional driving suggests current safe operating exposure levels require review to protect against long-term damage however with little evidence concerning the unique environment in which boats crews operate, the parity of these environments require investigation to allow direct comparison. Due to the prevalence of LBP in this population a need exists to establish the pathological process and add to the evidence base driving safe operating exposure levels.
Primary Care Trusts across the country are being encouraged to ration service provision due to austerity measures. Obesity has been suggested as a rationing tool with poor clinical outcomes sited as justification. There is, however, a lack of evidence in the literature pertaining to clinical outcomes post elective foot and ankle surgery in patients with an increased Body Mass Index (BMI). All patients undergoing elective foot and ankle surgery at Queen Alexandra Hospital, Portsmouth are entered into a prospective database, which includes their BMI at time of assessment in clinic. From this, we analysed the notes of all patients with a BMI ≥30, excluding any not operated on between July 2007 and August 2009 or with a BMI of <30 at time of surgery, to determine whether there was an increased incidence of peri- or post-operative complications. Included in the study were 109 patients with a mean age of 54 (range 21 - 79). Female patients accounted for 63% of those notes reviewed and the mean BMI was 34 (range 30 - 50). A mixture of hindfoot and forefoot procedures were carried out (20 different procedures). Median length of stay was 0 nights (range 0 – 15 days). The causes for excessive length of stays (>4 nights) included a pre operative Lower Respiratory Tract Infection missed prior to intubation and the initiation of CPAP post operatively in a patient with known Obstructive Sleep Apnoea. We found 3 cases of post operative Venous Thrombo-embolism within 3 months of surgery and 1 proven wound infection in a non-insulin dependent diabetic patient. Also noted were 3 non-unions, all requiring further surgery. Based on our historical evidence of infective and thrombo-embolic complications in patients with a BMI <30, we conclude that peri- and post-operative complications in obese patients occur no more frequently than in a patient population with a BMI <30.
