Outcomes of IED Foot And Ankle Blast Injuries

SLR- January 2014- Rebecca Omana-Daniels

Reference: Ramasamy, A., Hill, A. Masouros,S., Gibb, I., Phillip, R. Bull, A., Clasper, J. Outcomes of IED Foot and Ankle Blast Injuries. J Bone Joint Surg Am. 2013March 6; 95(25):1-7.

Scientific Literature Review 

Reviewed By: Rebecca Omana-Daniels, DPM
Residency Program: Madigan Army Medical Center

Podiatric Relevance: Blast injuries are becoming more prevalent in today’s society in both the military and civilian populations and podiatrists may be required to know how to properly treat and prepare for complications associated with blast injuries of the lower extremity. In a review of the previous literature, there has been no prior analysis of foot and ankle blast injuries as a result of improvised explosive devices. The aims of this study were to report the pattern of injury and determine whether specific elements of these injuries are associated with poor outcomes.
 

Methods: A retrospectivestudy was performed and a combat trauma registry was used to identify military personnelfrom 2006-2008. From this data, casualties who sustained a lower leg injury from a vehicle explosion were selected in the study. Traumatic amputations were excluded from the study. Sixty-three casualties with 89 foot and ankle injuries were included in the study. The mean follow up was 33 months. Foot and ankle injuries were categorized to the forefoot, midfoot, hindfoot, or tibia. The severity of the injury was measured with a foot and ankle severity scale. They were also classified as either closed or open.Timing of amputation was also categorized. Clinical end points were determined by the need of amputation and ongoing clinical symptoms. Overall functional outcome was determined by the ability of the patient toreturn to duty.

Results: Sixty-three active duty military patients (89 foot and ankle injuries) with lower extremity injuries were included. Fifty-one of the injuries sustained were multi-segmental to the foot and ankle. Twenty-six limbs (29 percent) required an amputation with six amputated for chronic pain 18 months after the initial injury. Of the 69 limbs initially salvaged, the overall infection rate was 42 percent, osteomyelitis was present in 11.6 percent of the patients and non-union rates were 21.7 percent. Symptomatic traumatic arthritis was noted in 33 percent of the salvaged limbs. At the final follow up, 66 (74 percent) of the injured limbs had persisting symptoms related to their injury, with only nine patient (14 percent) fit enough to return to their pre-injury state.
 

Conclusions: This study demonstrates that foot and ankle blast injuries are frequently associated with high amputation rates and an overall poor clinical outcome. These types of injuries are associated with long-term morbidity in an active population that may hinder them from returning to duty and/or life-style. Although similarities exist between civilian andmilitary complex foot injuries, the severity of the soft-tissue injury and the multi-segmental nature of blast foot injuries make them far more severe. From the authors’ data, new models of injury are being evaluated, and with more accurateinjury prediction models, it will be possible to improve protection of the lower extremity during blast injuries. This study it helps us better understand these types of traumatic injuries and better treat and council our patients.