Abstract
The accepted mechanism of traumatic limb amputation following blast is initial bone disruption due to the shock wave, with amputation completed by the blast wind; survival is considered unlikely. The high survival rate of traumatic amputees following explosion, from the current conflict in Afghanistan, is at odds with previous work.
We reviewed extremity injuries, sustained in Afghanistan by UK military personnel, over a 2 year period. 774 British servicemen and women sustained AIS >1 injuries, 72.6% of whom survived. No significant difference was found in the survival rates following explosive blast or gunshot (p>0.05).
169 casualties (21.8%) sustained 263 lower limb and 74 upper limb traumatic amputations. Amputations were more common in the lower than the upper limbs and more common in the extremity proximal bone. Bilateral lower limb amputations were more common than a unilateral lower limb amputation. The majority (99%) of major amputations were sustained as a result of explosion. 46.3% (74) of those who sustained a major amputation following explosion survived.
Rates of fatalities caused by explosion, or by small arms are not statistically different. Blast-mediated amputations are not universally fatal, and a significant number were through joint, calling into question previously proposed mechanisms.
