Primary surgical treatment of war injuries of the foot
Introduction
The complexity of foot anatomy is a result of the large number of small joints and bones, their attachment to ligaments and muscle tendons in the formation of longitudinal and transversal arches, and the large number of neurovascular elements. Contrary to injuries during peace-time, in military actions the foot is particularly exposed to the effect of mine blasts and fragments of explosive devices. Because of prevailing bone structures, isolated soft tissue injuries are rare. Contamination by polymorphous microorganisms is very common, which is the cause of doubtful prognosis in the treatment. Primary surgical treatment of war injuries of the foot requires a thoughtful procedure because of the probability of later amputations or deformities.
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Patients and methods
In the period June 1991–October 1995, at the Clinic of Traumatology and Orthopaedics of the Military Medical Academy (MMA), 1860 casualties with limb injuries from the battlefields of former Yugoslavia received primary surgical treatment. Of this number, 250 (13.4%) patients had missile injuries of the foot. Injuries to both feet were present in 25 (1.3%) patients, so that primary surgical treatment was performed on 275 feet. Patients who received primary surgical treatment prior to this date
Results
The most frequent cause of injury were the effects of mine blasts in 163 (65.2%) patients and of bullets from infantry firearms in 77 (30.8%) patients. Cause of injury could not be determined in 10 (4.0%) patients. Foot injuries were single injuries in 140 (56.0%) and combined with other injuries in 107 (42.8%) patients. In three (1.2%) cases the injuries were associated with burns. Injuries of the foot were associated with injuries of other limbs in 82 (76.6%), with thoracic and abdominal
Discussion
The development of explosive devices, especially all kinds of mines, was often of influence on the occurrence of foot injuries in the war, particularly the minefields left afterwards. The frequency of foot injuries inflicted by missiles from infantry firearms is smaller , these injuries often being accidental or self-inflicted. They are characterized by less destruction of the foot in comparison to the effect of a mine blast. There is little information in the literature regarding the frequency
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