Journal of the Royal Army Medical Corps
-
Haemodynamically unstable patients with mechanically unstable pelvic ring injuries continue to present a challenge to all personnel involved. Road traffic accidents remain a significant cause of soldier morbidity and mortality in peacetime and in war. These pelvic ring disruptions are markers of high-energy transfer injuries and are associated with fatal exsanguinating haemorrhage. ⋯ Dealing with these issues in the military environment adds additional stress to this volatile situation. Multidisciplinary practice guidelines have been shown to reduce mortality and should be adopted by all establishments treating these causalities. A well-rehearsed
ABC approach with a proactive approach to dot protection and promotion is ideal. -
Penetrating limb injuries are common during conflict, and in many there will be an associated fracture. Treatment of ballistic femoral fractures would usually be with by intramedullary nail; however, within the resource-constrained environment during conflict this is rarely possible. ⋯ We discuss the history of skeletal traction and its use in ballistic femoral fractures, and believe that skeletal traction is still a valuable technique that we shouldn't ignore. Military surgeons should be able to use skeletal traction to manage ballistic femoral fractures in the spartan environment of a deployed forward hospital.
-
Comparative Study
Limb complications following pre-hospital tourniquet use.
It has been stated that the application of a pre-hospital tourniquet could prevent 7% of combat deaths, however their widespread use has been questioned due to the potential risk from prolonged ischaemia. We reviewed members of the UK Armed Forces who sustained severe limb-threatening injuries in Iraq and Afghanistan, and performed a matched cohort study based on the presence or absence of pre-hospital tourniquet application. When a pre-hospital tourniquet had been applied, 19/22 patients had a least one complication compared to 15/22 where no tourniquet had been applied [p = 0.13]. ⋯ The significant difference in the incidence of major complications is a concern, particularly as the difference was mainly due to a deep infection rate of 32% vs. 4.5%. Although a number of variables could have influenced these small groups, such as choice of fracture fixation implant and method and timing of wound closure, the use of a matched cohort study design with a statistical significance level of p < 0.05, suggests the use of a pre-hospital tourniquet as a factor. Although the use of pre-hospital tourniquets cannot be decried as a result of this study, the need to continually prospectively review their use to determine their risk/benefit ratio remains.