Published infection rates following wounds sustained in combat vary dramatically. We reviewed UK military extremity trauma, sustained in Afghanistan over a two year period, to evaluate early infection rates and causative organisms. Data on wound site, time to onset of infection, organisms detected and method of presentation were collected. 351 patients had full datasets for clinical wound surveillance and microbiological data. 58 (16.5%) patients were diagnosed with wound infections. Median time to diagnosis was 17 days (range = 749, Interquartile range =31.75 days). Limb infection was detected in 53 (15.1%) patients. Infection was statistically significantly more likely to be incurred in the lower extremity (p=0.0220). Multiple organisms were identified in 34 (64.2%) of the 53 patients with a limb infection. Fungi were significantly more common in early presenters (<30 days after injury) (p=0.0024). The overall infection rates recorded are low when compared to historical data. Organisms isolated from infected wounds are frequently multiple. The microbial spectrum and the number of organisms present on diagnosis change with time from wounding.
Traumatic amputations (TAs) are amongst the most significant orthopaedic sequelae following IED strikes. Biomechanically, longer residual limb length confers better function. However, post-trauma definitive through knee amputation (TKA) remains controversial. UK military casualties sustaining ≥1 major TA, 01/08/2008–01/08/2010 were identified using the UK JTTR and post mortem CT databases. All through- and below-knee TAs were termed ‘potential TKAs’ (p-TKAs); hypothetical candidates for definitive TKA. We hypothesised that traumatic TKAs were more common than previously reported (4.5% of lower limb TAs) and a significant cohort of blast injuries exist suitable for definitive TKA. 146 cases (75 survivors, 71 fatalities) sustained 271 TAs (235 lower limb). TKA rate was 34/235 (14.2%). 63/130 survivor TAs and 66/140 fatality TAs merited analysis as p-TKAs. Detailed pathoanatomy was only available for fatality p-TKAs, for whom definitive TKA would have been proximal to the zone of injury (ZOI) in only 3/66 cases. Blast-mediated traumatic TKAs are significantly more common than previously reported (
The accepted mechanism of traumatic limb amputation following blast is initial bone disruption due to the shock wave, with amputation completed by the blast wind; survival is considered unlikely. The high survival rate of traumatic amputees following explosion, from the current conflict in Afghanistan, is at odds with previous work. We reviewed extremity injuries, sustained in Afghanistan by UK military personnel, over a 2 year period. 774 British servicemen and women sustained AIS >1 injuries, 72.6% of whom survived. No significant difference was found in the survival rates following explosive blast or gunshot (p>0.05). 169 casualties (21.8%) sustained 263 lower limb and 74 upper limb traumatic amputations. Amputations were more common in the lower than the upper limbs and more common in the extremity proximal bone. Bilateral lower limb amputations were more common than a unilateral lower limb amputation. The majority (99%) of major amputations were sustained as a result of explosion. 46.3% (74) of those who sustained a major amputation following explosion survived. Rates of fatalities caused by explosion, or by small arms are not statistically different. Blast-mediated amputations are not universally fatal, and a significant number were through joint, calling into question previously proposed mechanisms.
