Orthopaedic Injuries

Orthopaedic injuries following explosions are most commonly the result of secondary, tertiary and quaternary blast injury.

In the case of traumatic amputation, however, primary blast injury has been strongly implicated as the mechanism of injury [3]. It is an uncommon injury in survivors as its presence indicates exposure to massive blast over-pressures [1,4].

The level of amputation is most commonly the level of the upper third of the tibia [1].

It has been postulated that the pressure transmitted from the primary blast wave to the long bone fractures through the shaft of the long bone, usually at the level of the diaphysis.

The force of the subsequent blast wind then separates the limb from the body [1].

Management in the ED should focus on control of haemorrhage, analgesia and meticulous exclusion of other life-threatening primary blast injuries.

In cases of life-threatening extremity trauma secondary to blast injuries, early use of tourniquets may prove lifesaving beside haemostatic agents.

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