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Scientific Articles   |    
Outcomes of IED Foot and Ankle Blast Injuries
Major Arul Ramasamy, MA, MRCS, DMCC, RAMC1; Captain Adam M. Hill, PhD, MRCS, MIMechE, RAMC1; Spyridon Masouros, Dip Eng, PhD1; Lieutenant-Colonel Iain Gibb, FRCS(Ed), FRCR, RAMC2; Lieutenant-Colonel Rhodri Phillip, MRCP, RAMC3; Anthony M.J. Bull, PhD, FIMechE1; Colonel Jon C. Clasper, DPhil, MBA, FRCS, L/RAMC1
1 Imperial Blast Biomechanics and Biophysics Group, Room 4.28, Royal School of Mines, Imperial College London, South Kensington, London SW7 2AB, United Kingdom. E-mail address for A. Ramasamy: a.ramasamy09@imperial.ac.uk
2 Centre for Defence Imaging, Fort Blockhouse, Gosport, Hants PO12 2AB, United Kingdom
3 Defence Medical Rehabilitation Centre, Headley Court, Epsom, Surrey KT18 6JN, United Kingdom
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Investigation performed at the Imperial Blast Biomechanics and Biophysics Group, Imperial College London, London, United Kingdom



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Mar 06;95(5):e25 1-7. doi: 10.2106/JBJS.K.01666
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Abstract

Background: 

Improvements in protection and medical treatments have resulted in increasing numbers of modern-warfare casualties surviving with complex lower-extremity injuries. To our knowledge, there has been no prior analysis of foot and ankle blast injuries as a result of improvised explosive devices (IEDs). The aims of this study were to report the pattern of injury and determine which factors are associated with a poor clinical outcome.

Methods: 

U.K. service personnel who had sustained lower leg injuries following an under-vehicle explosion from January 2006 to December 2008 were identified with the use of a prospective trauma registry. Patient demographics, injury severity, the nature of the lower leg injury, and the type of clinical management were recorded. Clinical end points were determined by (1) the need for amputation and (2) ongoing clinical symptoms.

Results: 

Sixty-three U.K. service personnel (eighty-nine injured limbs) with lower leg injuries from an explosion were identified. Fifty-one percent of the casualties sustained multisegmental injuries to the foot and ankle. Twenty-six legs (29%) required amputation, with six of them amputated because of chronic pain eighteen months following injury. Regression analysis revealed that hindfoot injuries, open fractures, and vascular injuries were independent predictors of amputation. At the time of final follow-up, sixty-six (74%) of the injured limbs had persisting symptoms related to the injury, and only nine (14%) of the service members were fit to return to their preinjury duties.

Conclusions: 

This study demonstrates that foot and ankle injuries from IEDs are associated with a high amputation rate and frequently with a poor clinical outcome. Although not life-threatening, they remain a source of long-term morbidity in an active population.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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