Abstract

Scapula fractures mostly occur following high energy trauma, however, the demographics are unknown in deployed soldiers. We analysed the incidence, aetiology, associated injuries, treatment and complications of these fractures in military personnel from Afghanistan and Iraq (2004–2014). Forty-four scapula fractures from 572 upper limb fractures (7.7%) were sustained. 85% were caused by blast or gunshot wounds and 54% were open blast fractures. Multiple injuries were noted including lung, head, vascular and nerve injuries. Injury Severity Scores were almost double compared to the average upper limb injury without a scapula fracture (21 vs. 11). Brachial plexus injuries (17%) have a favourable outcome following GSW compared to blast injuries. Glenoid fractures or floating shoulders were internally fixed (10%) and resulted from high velocity gunshot wounds or mounted blast ejections. There were no cases of deep soft tissue infection or osteomyelitis and all scapula fractures united. Scapula fractures have a 20 times higher incidence in military personnel compared to the civilian population. These fractures are often associated with multiple injuries, including brachial plexus injuries, where those sustained from blast have less favourable outcome. High rates of union following fixation and low rates of infection are expected despite significant contamination and soft tissue loss.

Major upper limb arterial injuries sustained in combat are associated with significant trauma. We analysed the survival and complication rates following upper limb vascular injury in Iraq and Afghanistan (2004–2014). Fifty-two soldiers sustained 59 major arterial injuries in 54 limbs. Axillary artery injuries were more likely to be caused by gunshot wounds (86%), whilst brachial and ulnar artery injuries were primarily associated with blasts (72% and 87% respectively); no such correlation was identified with radial artery injuries. Apart from three temporary shunts, all vascular injuries were treated definitively in the local field hospital before repatriation. Proximal injuries were predominantly treated with long saphenous vein grafts and distal injuries with ligation. One soldier required an immediate amputation following failed LSV grafting, however no amputations followed repatriation. There were five identified graft failures (21%), although these were not associated with subsequent perfusion issues. There were no graft failures following temporary shunting. Associated nerve injuries often required operative intervention and have a guarded outcome. 100% of radial fractures went onto non-union if combined with a radial artery injury. Successful immediate re-perfusion of a vascular compromised upper limb correlates with excellent long-term limb survival, despite a significant number of grafts developing secondary failure.

We present the results of a bi-centre, retrospective study examining the clinical, functional and radiological outcomes of distal radius fracture fixation with the Aptus locking plates and Tri-Lock® variable angle locking screws. We assessed 61 patients with distal radius fractures with a minimum of six months follow-up. Functional assessment was made using the DASH score. We measured wrist range of movement and grip strength, and reviewed radiographs to assess restoration of anatomy, fracture union and complications. All fractures united within six weeks. Mean ranges of movement and grip strength were only mildly restricted compared to the normal wrist. The mean DASH score was 18.2. Seven patients had screws misplaced outside the distal radius although 3 of these remained asymptomatic. Five other patients developed minor complications. Variable angle locking systems benefit from flexibility of implant positioning and may allow enhanced inter-fragmentary reduction for accurate fixation of intra-articular fractures. However, variable-angle systems may lead to increased rates of screw misplacement.