Elsevier

Injury

Volume 33, Issue 2, March 2002, Pages 167-171
Injury

Hindfoot injuries due to landmine blast accidents

https://doi.org/10.1016/S0020-1383(01)00092-4Get rights and content

Abstract

Landmines were initially developed as anti-tank weapons. They are still used indiscriminately and in a disorganised fashion, violating the United Nations Treaty on their use [United Nations (1980)].

The injury produced by these devices is variable depending upon the construction and strength of the landmine and body parts coming in contact with the landmine at the time of detonation.

The purpose of the present study was to report the type of landmine-blast injuries of the lower limbs and the surgical options available to treat them.

Twenty-eight patients, all with lower limb injuries were included in the present study. They had received injuries on the control line of the troubled Jammu and Kashmir regions in the north of Pakistan. All were male patients between the age of 13 and 55 years. A salvage procedure for the forefoot was possible on four patients only and all the rest had a below-knee amputation. Time lapsed between the injury and receiving medical help was the crucial determining factor as to the final outcome of the limb.

We believe that the pattern of injury, amount of energy dissipation and part of body in contact with the landmine at the time of explosion are the main determining factors for the final outcome. If skin along with the underlying soft tissue and the neuro-vascular structures on the dorsum of the foot are spared then an attempt can be made at limb salvage.

Introduction

Landmines were developed as anti-tank weapons. The basic device consists of artillery shells with exposed fuses, buried in the path of advancing troops. Advances in the warfare have led to the development of more sophisticated antipersonnel mines and booby traps in all shapes and sizes. The demoralising effect of these mines is obvious on the enemy troops since they cause devastating damage to the advancing warfare and the personnel. The proclamations of the Geneva Convention of 1949 imposed constraints on the conduct of war. Landmines though, are still used indiscriminately and in a disorganised fashion in contravention to the United Nations Treaty on their use (United Nations, 1980).

The injury produced by these devices is variable depending upon the type of the device and body parts coming in contact with the landmine at the time of detonation. It involves the lower limbs, perineum and upper half of the body in that order [1], [2], [3], [4], [5]. The earth, mud and projectiles penetrating deep into the tissue spaces contaminate the wound.

The nations worst affected by this plague of landmines are Afghanistan, Iraq, African countries and now Kashmir. Pakistan due to its geographical location provides refuge to many of the unfortunate landmine victims from across the border and many of them are therefore referred for treatment to the referral hospitals in larger cities.

The purpose of the present study was to report the type of landmine-blast injuries of the lower limbs and the surgical options available to treat them. We have reviewed the available literature and a brief résumé is presented here. Treatment protocols were reviewed and follow-up arranged for the affected victims prospectively where possible.

Section snippets

Patients and methods

Data were collected prospectively on all the landmine victims (with lower limb involvement) reporting to this unit. Twenty-eight patients, all with lower limb injuries were included in the present study. They had received injuries on the control line of the troubled Jammu and Kashmir regions in the north of Pakistan. All were male patients between the ages of 13 and 55 years. Twenty-one of them were peasants and seven Mujahidine (freedom fighters) also came for treatment.

Only six reported

Limb salvage

A salvage procedure for the forefoot was possible in four of the patients. They had all presented within 24 h of injury, the neuro-vascular structures (dorsalis paedis artery) for the dorsal skin of the ankle and forefoot were spared but hindfoot (talus and calcaneus) were badly mutilated (Table 1 and Fig. 1).

Good capillary return was confirmed before embarking on limb salvage. The presence of fractures in the ankle and/or foot bones was not considered as a contraindication to limb salvage but

Results

Below-knee amputation was the most commonly performed procedure in 22 patients presenting more than 24 h after the accident. This was usually a completion of the traumatic amputation caused by the explosion itself. A distal tibial amputation (just above the ankle — leaving as long a tibial stump as possible) was attempted, to make a load-bearing stump in 19 patients. Wound healing was not a problem in any of the cases and none developed chronic infection. None required revision to a more

Discussion

In every conflict since the Second World War, antipersonnel mines have been used in large numbers [7]. They continue to be a public hazard in war zones [8], [7], [1], [9], [10]. Once laid, the landmines become a blind weapon that cannot distinguish between friend or enemy. Civilians not actually involved in the fighting [8], [9], [11], [10] can constitute up to 29% of all the landmine victims as shown in studies from Afghanistan and Cambodia [8], [9]. In these studies 16% were women and 7%

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