TY - JOUR PY - 2022// TI - Isolated limb fractures - the underestimated injury in the Israeli Defence Forces (IDF) JO - Injury A1 - Ran, Yuval A1 - Mitchnik, Ilan A1 - Gendler, Sami A1 - Avital, Guy A1 - Radomislensky, Irina A1 - Bodas, Moran A1 - Benady, Amit A1 - Benov, Avi A1 - Almog, Ofer A1 - Chen, Jacob SP - ePub EP - ePub VL - ePub IS - ePub N2 - INTRODUCTION: Musculoskeletal injuries dominate warfare-related trauma and differ from civilian settings in higher hospitalization costs, morbidity, and mortality. Partly due to introduction of personal protective equipment in the Israel Defence Force (IDF) to minimize head and torso injuries while the extremities remained unprotected. This study describes military extremity injury patterns, prehospital treatment and injury sequela regarding return-to-duty and disability compensation.

METHODS: This retrospective study examined cases of battle and non-battle trauma casualties treated by the IDF Medical Corps from 2013 to 2020. Data from the IDF Trauma Registry (IDF-TR) was merged with The Israeli National Trauma Registry (INTR). Cases with high morbidity discharged from military service were compared with lower morbidity patients who returned to active duty service.

RESULTS: Out of 1360 injured soldiers, 280 (20.6%) were found to have isolated limb fractures (ILFs). High morbidity casualties had more open fractures (63% vs. 42%) and higher involvement of lower extremities (79% vs. 58%) (p < 0.001), higher rates of tourniquets use (28% compared to 9%, p < 0.001), external fixation (34% vs. 19%, p < 0.001) and amputations (9% vs. 1%, p = 0.003), required more rehabilitation (34% vs. 7%, p < 0.001), and had 46% medical disabilities compared to 24% with low morbidity (p < 0.001).

CONCLUSIONS: ILFs are associated with significant morbidity and disability. High morbidity is associated with high energy, scar-producing, lower-extremity open fractured limbs treated by tourniquets. Future studies should evaluate whether junctional or extremity protective gear is combat feasible and whether introducing Clinical Practice Guidelines to manage suspected limb fractures can decrease morbidity rates and improve return to duty.

Language: en

LA - en SN - 0020-1383 UR - http://dx.doi.org/10.1016/j.injury.2022.11.014 ID - ref1 ER -