Blast and fragment injuries of the musculoskeletal system
are the most frequently encountered wounds in modern warfare.
Most injuries to the musculoskeletal system involve so-called
secondary blast injuries in which casing fragments and other debris
become flying projectiles.
Nonoperative treatment of selected wounds caused by small-fragment
debris has been successful but remains controversial.
Successful surgical treatment depends on meticulous wound dï¿½bridement,
with excision of nonviable tissue and foreign material likely to
cause infection; adequate drainage; and delayed closure.
Advanced internal fixation techniques used in modern trauma centers
to treat predominantly blunt trauma may not be appropriate for care
of orthopaedic war wounds in a field setting.