title: A correlation analysis of metacarpal & phalangeal injury pattern from improvised explosive devices amongst armed force personnel.
abstract: Injuries to the hand during military combat operations, particularly from improvised explosive devices (IEDs) have a significant impact on form, function, mental health and future employment but remain underreported amidst the life and limb-threatening emergencies that garner more attention. An understanding the patterns of hand injuries encountered from IEDs is crucial to optimizing reconstruction and rehabilitation. The aim of this study was to re-evaluate hand injury sustained from IED in order to understand the clinical burden for reconstruction and direct the focus for future hand protection. We identified 484 hand injuries in 380 patients sustained as a result of IEDs among military personnel service in Afghanistan between 2006 and 2013. 53% of all surviving military personnel injured by IEDs sustain injuries to the hand. Analysis of the 103 patients who sustained injury to the metacarpal, phalanges or digital amputation revealed that the middle and ring fingers are most commonly injured. Amputation to the ring finger is strongly associated with injury to the adjacent fingers and amputations to the middle, ring and little fingers concurrently is a commonly observed pattern. The proximal phalanges of the middle and ring fingers had a strong correlation for fracture together. These findings disprove the conventional belief in an ulnar focus of injury and support the quest for a development of combat hand protection that addresses the injury pattern seen.
authors.affiliation: Core Surgical Trainee, London Deanery, United Kingdom. Electronic address: Robmtstaruch@doctors.org.uk.
authors.forename: R M T
authors.initials: RM
authors.lastname: Staruch
authors.affiliation: University of Oxford, United Kingdom.
authors.forename: G E
authors.initials: GE
authors.lastname: Glass
authors.affiliation: East of England Deanery, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Johnson
authors.affiliation: Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom.
authors.forename: J
authors.initials: J
authors.lastname: Hodson
authors.affiliation: St Mary's Hospital, Praed Street, London, United Kingdom; St Mary's Hospital, London, United Kingdom.
authors.forename: S P
authors.initials: SP
authors.lastname: Hettiaratchy
authors.affiliation: Plastic & Reconstructive Surgery, HM Forces, United Kingdom; Queen Elizabeth Hospital Birmingham & Royal Centre for Defence Medicine, Birmingham, United Kingdom.
authors.forename: A R
authors.initials: AR
authors.lastname: Kay
authors.affiliation: Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom.
authors.forename: D
authors.initials: D
authors.lastname: Chester
mesh_terms: D055826:Afghan Campaign 2001-; D000673:Amputation, Traumatic / Q000453:epidemiology / Q000523:psychology / Q000601:surgery*; D001753:Blast Injuries / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D053834:Explosive Agents; D050278:Finger Phalanges / Q000293:injuries; D050723:Fractures, Bone / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D006230:Hand Injuries / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008016:Life Change Events; D050279:Metacarpal Bones / Q000293:injuries; D008887:Military Medicine; D008889:Military Personnel; D019651:Plastic Surgery Procedures / Q000379:methods*; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D053834:Explosive Agents
keywords: Amputation; Blast; Improvised explosive device; Military; Trauma; Upper limb