Traumatic amputation by explosive blast: pattern of injury in survivors
Explosive blast causes a pattern of injury including primary blast lung, secondary .fragment injury and traumatic amputation of limbs. Major traumatic amputation is rare in survivors of bomb blast but common in those who die. The mechanism of such injury has not been previously determined, but must be established ij' protective measures are to be developed for members of the armed.forces. The nature o f 4 1 traumatic amputations in 29 servicemen who survived to reach medical care after blast injury was investigated to determine the anatomical level of amputation and the pattern of soft tissue damage. Joints were an infrequent site of amputation and the tibia1 tuberosity was a particularly frequent site of lower-limb severance. Comparison of the pattern of injury was made with that seen in ejecting fast-jet pilots, who jrequently sufler major,flailing injury; there appears to be a substantially diflerent injury diStribUtiOF2. The accepted mechanism of traumatic amputation, avulsion by the dynamic overpressure, is challenged: it is suggested that the shockwave resulting from an explosion is capable of causing at least bone disruption in a limb.