Orthopedic Blast and Shrapnel Trauma

Military experience managing complex blast injuries during the long conflicts in Afghanistan and Iraq has advanced the understanding of the biophysics of blast trauma and has allowed for the development of treatment algorithms to manage associated injuries. Military blast-injured patients typically arrive in extremis, often with severe pelvic or perineal injuries and extremity amputations. Resource demand for even one of these patients can be quite significant, and in austere environments can severely impact the reserves of the managing facility. The management and resuscitation protocols developed by the military can be directly applied in managing civilian blast casualties. Further, as the 2013 Boston Marathon bombing and other examples have demonstrated, civilian healthcare providers must be prepared to employ such management strategies in mass casualty scenarios, both in austere and well-resourced environments. War surgery principles, including liberal application of tourniquets in the field, the use of novel resuscitation algorithms, temporary vascular shunts as well as fixation of fractures proximal to amputations, may have substantial utility in civilian trauma settings. The military experience has shown that improvements in point-of-contact care and standardization of post-injury management have led to an increase in survivability after severe blast trauma. After over 10 years of ongoing conflict in Iraq and Afghanistan, civilian orthopedic trauma surgeons can now benefit from this clinical and research knowledge base.