Elsevier

Injury

Volume 31, Issue 3, April 2000, Pages 193-197
Injury

Primary surgical treatment of war injuries of the foot

https://doi.org/10.1016/S0020-1383(99)00271-5Get rights and content

Abstract

Presented are the results of primary surgical treatment of war injuries of the foot in 250 patients wounded in the territory of former Yugoslavia in the period June 1991–October 1995. Total number of feet treated was 275. Aetiologically, the most frequent injuries were those inflicted by the effect of mine blasts (65.2%) and by bullets from firearms (30.8%). Injuries to a single foot were present in 140 (56.0%), combined injuries in 107 (42.8%) and associated with burn injuries in three (1.2%) patients. Soft tissue injuries were present in 25 (9.1%) and injuries to bone structures and joints in 250 (90.9%) feet. Injuries resulting from solid blasts were found in nine (3.2%) feet. Postoperative bone fragment stabilization was required in 115 (41.8%) feet. Stabilization was by plaster of Paris in 87 (75.6%) and by external fixation in 23 (20.0%) feet. Amputations were performed in 73 (26.5%) feet. Covering of soft tissue and bone defects was required in 84 (33.6%) patients.

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.

Section snippets

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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