title: Outcomes of IED foot and ankle blast injuries.
abstract: BACKGROUND
  Improvements in protection and medical treatments have resulted in increasing numbers of modern-warfare casualties surviving with complex lower-extremity injuries. To our knowledge, there has been no prior analysis of foot and ankle blast injuries as a result of improvised explosive devices (IEDs). The aims of this study were to report the pattern of injury and determine which factors are associated with a poor clinical outcome.
  
  
  METHODS
  U.K. service personnel who had sustained lower leg injuries following an under-vehicle explosion from January 2006 to December 2008 were identified with the use of a prospective trauma registry. Patient demographics, injury severity, the nature of the lower leg injury, and the type of clinical management were recorded. Clinical end points were determined by (1) the need for amputation and (2) ongoing clinical symptoms.
  
  
  RESULTS
  Sixty-three U.K. service personnel (eighty-nine injured limbs) with lower leg injuries from an explosion were identified. Fifty-one percent of the casualties sustained multisegmental injuries to the foot and ankle. Twenty-six legs (29%) required amputation, with six of them amputated because of chronic pain eighteen months following injury. Regression analysis revealed that hindfoot injuries, open fractures, and vascular injuries were independent predictors of amputation. At the time of final follow-up, sixty-six (74%) of the injured limbs had persisting symptoms related to the injury, and only nine (14%) of the service members were fit to return to their preinjury duties.
  
  
  CONCLUSIONS
  This study demonstrates that foot and ankle injuries from IEDs are associated with a high amputation rate and frequently with a poor clinical outcome. Although not life-threatening, they remain a source of long-term morbidity in an active population.
authors: Imperial Blast Biomechanics and Biophysics Group, Imperial College London, South Kensington, London, UK. a.ramasamy09@imperial.ac.uk
authors: Arul
authors: A
authors: Ramasamy
authors: Adam M
authors: AM
authors: Hill
authors: Spyridon
authors: S
authors: Masouros
authors: Iain
authors: I
authors: Gibb
authors: Rhodri
authors: R
authors: Phillip
authors: Anthony M J
authors: AM
authors: Bull
authors: Jon C
authors: JC
authors: Clasper
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D016512:Ankle Injuries / Q000209:etiology / Q000601:surgery*; D001753:Blast Injuries / Q000209:etiology / Q000601:surgery*; D054042:Bombs; D005500:Follow-Up Studies; D018409:Foot Injuries / Q000209:etiology / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D054542:Iraq War, 2003-2011; D023821:Limb Salvage / Q000706:statistics & numerical data*; D016015:Logistic Models; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery; D020127:Recovery of Function; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome