Explosions remain the leading cause of death and injury to combatants in conflict. The current ‘Global War on Terror’ has resulted in a shift of explosive-related injuries from the battlefield into civilian centres. Despite musculoskeletal injuries being the most common injury witnessed in blast, there remains little research into the effects of blast on this system. In order to develop new treatment regimens and mitigation systems, there is a requirement to have a better understanding of skeletal trauma in this unique environment. The aim of this review article is to deconstruct the complex injury mechanisms witnessed in blast and relate them to its effects on the musculoskeletal system.
BakerW (1983) Explosion Hazards and Evaluation. Amsterdam, Netherlands: Elsevier.
2.
BellamyRFVayerJS(1988) Assessment of penetrating injury severity. In: MaullKIClevelandHCStrauchGO (eds) Advances in Trauma. Chicago, IL: Year Book Publishers Inc.
BowenIGAlbrightRWFletcherER (1961) CEX-58.9 A Model Designed to Predict the Motion of Objects Translated by Classical Blast Waves. Oak Ridge, TN: Department of Commerce.
5.
BowenIGFletcherERRichmondDR (1968) Estimate of Man's Tolerance to the Direct Effects of Air Blast. Washington DC: Headquarters Defence Atomic Support Agency.
6.
BoydNA (1975) A military surgical team in Belfast. Ann R Coll Surg Engl. 56: 15–25.
7.
BrownKVMurrayCKClasperJC (2010) Infectious complications of combat-related mangled extremity injuries in the British Military. J Trauma. 69: S109–S115.
8.
BywatersEGLBeallD (1941) Crush injuries with impairment of renal function. BMJ. 1: 427–432.
9.
CallenderGRFrenchRW (1935) Wound ballistics: Studies in the mechanism of wound production by rifle bullets. Milit Surg. 77: 177–201.
10.
CampbellWW (2008) Evaluation and management of peripheral nerve injury. Clin Neurophysiol. 119: 1951–1965.
11.
ChampionHRHolcombJBYoungLA (2009) Injuries from explosions: physics, biophysics, pathology and required research focus. J Trauma. 66: 1468–1477.
12.
ClasperJC (2001) The interaction of projectiles with tissues and the management of ballistic fractures. J R Army Med Corps. 147: 52–61.
CooperGJTownendDJCaterSR (1991) The role of stress waves in thoracic visceral injury from blast loading: modification of stress transmission by foams and high-density materials. J Biomech. 24: 273–285.
15.
CullisIG (2001) Blast waves and how they interact with structures. J R Army Med Corps. 147: 16–26.
16.
DeweyJM (1964) The air velocity in blast waves from TNT explosions. Proc R Soc Lond A. 279: 366–385.
17.
FriedlanderFG (1946) The diffraction of sound pulses. I. Diffraction by a semi-infinite plane. Proc R Soc Lond A. 186: 322–344.
18.
FrykbergERTepasJJIII (1988) Terrorist bombings. lessons learned from Belfast to Beirut. Ann Surg. 208: 569–569.
19.
GreavesIPorterKSmithJE (2004) Consensus statement on the early management of crush injury and prevention of crush syndrome. J R Army Med Corps. 150: 102–106.
HofmannARitzUHessmannMH (2008) Extracorporeal shock wave-mediated changes in proliferation, differentiation, and gene expression of human osteoblasts. J Trauma. 65: 1402–1410.
22.
HoldenCE (1979) The pathophysiology and prevention of Volkmann's ischaemic contracture. J Bone Joint Surg Br. 61: 296–300.
23.
HorrocksCL (2001) Blast injuries: Biophysics, pathophysiology and management principles. J R Army Med Corps. 147: 28–40.
24.
HullJB (1992) Traumatic amputation by explosive blast: Pattern of injury in survivors. BJS. 79: 1303–1306.
25.
Hull JB (1995) An investigation into the mechanism of traumatic amputation by explosive blast. Doctor of Medicine, University of Birmingham.
26.
HullJBCooperGJ (1996) Pattern and mechanism of traumatic amputation by explosive blast. J Trauma. 40: S198–S205.
27.
JagodzinskiNAWeerasingheCPorterK (2010) Crush injuries and crush injuries – a review. Trauma. 12: 133–148.
28.
KressTAPortaDJSniderJN (1995) Fracture patterns of human cadaver long bones. IRCOBI. Brunnen: IRCOBI.
29.
LiuYChenXChenSLX (1988) Wounding effects of small fragments of different shapes at different velocities on soft tissues of dogs. J Trauma. 28: S95–S98.
30.
LundborgGMyersRPowellH (1983) Nerve compression injury and increased endoneurial pressure: a “miniature compartment syndrome”. J Neurol Neurosurg Psychiatry. 46: 1119–1124.
31.
MaierMMilzSTischerT (2002) Influence of extracorporeal shock-wave application on normal bone in an animal model in vivo: Scintigraphy, MRI and histopathology. J Bone Joint Surg [Br]. 84–B: 592–599.
32.
MazurekMTFickeJR (2006) The scope of wounds encountered in casualties from the Global War on Terrorism: from the battlefield to the tertiary treatment facility. J Am Acad Orthop Surg. 14: S18–S23.
33.
McClureSRVan SickleDWhiteMR (2004) Effects of extracorporeal shock wave therapy on bone. Vet Surg. 33: 40–48.
34.
McMillenJH (1945) Shock wave pressures in water produced by impact of small spheres. Phys Rev. 68: 198–209.
35.
MelsomMAFarrarMDVolkersRC (1975) Battle casualties. Ann R Coll Surg Engl. 56: 289–303.
36.
MitchinerPH (1939) Wounds of the peripheral nerves and blood vessels. BMJ. 2: 124–126.
37.
Nechaev EA, Gritsanov AI, Fomin NF, et al. (1994) Mine Blast Trauma. St Petersberg, Russia: Russian Federation Ministry of Public Health and Medical Industry.
OwensBDKraghJFJrMacaitisJ (2007) Characterization of extremity wounds in Operation Iraqi Freedom and Operation Enduring Freedom. J Orthop Trauma. 21: 254–257.
40.
PalinkasLACohenP (1985) Combat casualties among US Marine Corps personnel in Vietnam: 1964-1972. San Diego, CA, USA: Naval Health Research Centre.
41.
RamasamyAHarrissonSLasradoI (2009a) A review of casualties during the Iraqi insurgency 2006-a British field hospital experience. Injury. 40: 493–497.
42.
RamasamyAHarrissonSEStewartMP (2009b) Penetrating missile injuries during the Iraqi insurgency. Ann R Coll Surg Engl. 91: 551–558.
43.
RamasamyAHillAMMasourosSD (2010) Blast-related fracture patterns: a forensic biomechanical approach. J R Soc Interface. 8: 689–698.
44.
RamasamyAMasourosSDNewellN (2011) In-vehicle extremity injuries from improvised explosive devices: current and future foci. Phil T Roy Soc B. 366: 160–170.
45.
ReisNDMichaelsonM (1986) Crush injury to the lower limbs. Treatment of the local injury. J Bone Joint Surg Am. 68: 414–418.
46.
RitenourAEDorlacWCFangR (2008) Complications after fasciotomy revision and delayed compartment release in combat patients. J Trauma. 64: S153–S162.
47.
RoseSCFujisakiCKMooreEE (1988) Incomplete fractures associated with penetrating trauma: etiology, appearance and natural history. J Trauma. 28: 106–109.
48.
RyanJMRichNMOchsnerMG(1997) Biophysics and pathophysiology of penetrating trauma. In: RyanJMRichNMDaleRF (eds) Ballistic Trauma. London: Arnold.
49.
SeddonHC (1942) A classification of nerve injuries. BMJ. 2: 237–239.
50.
StapleySACannonLB (2006) An overview of the pathophysiology of gunshot and blast injury with resuscitation guidelines. Current Orthopaedics. 20: 322–332.
51.
SunesanAHansenHASeemanT (1987) Peripheral high-energy missile hits cause pressure changes and damage to the nervous system: experimental studies on pigs. J Trauma. 27: 782–789.
52.
SunesanAHansenHASeemanT (1990) Pressure wave injuries to the nervous system caused by high-energy missile extremity impact: Part I. Local and distant effects on the peripheral nervous system – a light and electron microscopy study on pigs. J Trauma. 30: 281–294.
53.
TrimbleKClasperJC (2001) Anti-personnel mine injury; mechanism and medical management. J R Army Med Corps. 147: 73–79.
54.
ValchanouVDMichailovP (1991) High energy shock waves in the treatment of delayed and nonunion of fractures. Int Orthop. 15: 181–184.
55.
WakeleyCPG (1945) Effect of underwater explosion on the human body. Lancet. 245: 715–718.
56.
WallEJMassieJBKwanMK (1991) Experimental stretch neuropathy changes in nerve conduction under tension. J Hand Surg. 16: 859–863.
ZiouposPHansenUCurreyJD (2008) Microcracking damage and the fracture process in relation to strain rate in human cortical bone tensile failure. J Biomech. 41: 2932–2939.
59.
ZuckermanS(1952) Vulnerability of human targets to fragmenting and blast weapons. In: ZuckermanS (ed.) Textbook of Air Armament. London, UK: HMSO, pp. 1–243.
