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Improvised explosive devices The characteristic weapon of modern warfare has been the IED, which was the leading cause of death among coalition 22 troops during conflicts in Iraq and Afghanistan. devices may range from rudimentary homemade explosives to sophi...

INTRODUCTION The treatment of war wounds is as ancient as warfare itself. The Edwin Smith papyrus has been dated to 1600 /uni00A0 /b.sc/c.sc/e.sc is the oldest known treatise on trauma surgery and anatomy . The history of battlefield surgery is the history of...

Learning objectives To understand and appreciate: Fundamental differences of war surgery • Injury patterns of modern warfare • Learning objectives To understand and appreciate: Fundamental differences of war surgery • Injury patterns of modern warfare • Learni...

MANAGEMENT OF GUNSHOT WOUNDS The management of gunshot wounds in a conflict setting may - di ff er from that in civilian practice. The typical low-energy wounds caused by pistols are sometimes managed conserva - tively in civilian trauma centres with adequate w...

MASSIVE TRANSFUSION While haemorrhage control prior to the need for massive transfusion is ideal, this is often not the case. The degree of injury and associated massive blood loss associated with war injuries may necessitate large-volume transfusion. The use ...

MEDICAL EVACUATION Medical evacuation refers to the movement and en route care of casualties within a conflict zone. The evacuation may be the initial movement from a battlefield or between other more sophisticated echelons of care, up to and including repatri...

MEDICAL SUPPORT ROLES The term ‘role’ is used to designate the tiers of medical support 2 that integrate into a modern military operation. An apprecia tion of the capabilities and limitations of these roles is essential to improving the care of casualties at...

PRINCIPLES OF WAR SURGERY Battlefield death occurs early (or immediately) because of devastating central nervous system injury and haemorrhage, or - - - late because of infection. Some of the injuries causing imme - diate death (including brain, heart and gre...

Primary blast injury Primary blast injuries result from the overpressure and are, as such, unique to blast. The e ff ect of blast overpressure is most marked at the interface between air and tissue or liquid. Tympanic membrane (TM) rupture is the most common p...

Quaternary and quinary injury Quaternary blast injury refers to a miscellaneous group of injuries that do not fall within other categories. These include burns, inhalational injuries and late-onset respiratory prob lems. Quinary injury refers to injury caused ...

REFERENCES 1 Atta HM. Edwin Smith Surgical Papyrus: the oldest known surgi - cal treatise. Am Surg 1999; 65 (12): 1190–2. 2 North Atlantic Treaty Organization. NATO logistics handbook . Brus - sels: NATO Headquarters, 2012. Available from https://www .nato. in...

SURGERY Modern warfare has changed over recent decades. The causes of injury are particular to the individual conflict, nation and 9 armed service. Historically , penetrating trauma was predom inantly sustained by combat infantry , whereas naval and air person...

Secondary blast injury Secondary blast injury refers to the e ff ect of fragments that are accelerated away from the device following detonation. Sources of fragments include: /uni25CF the casing of the device; /uni25CF purposefully placed fragments within t...

Tertiary blast injury Tertiary blast injury is the result of gross movement of person - nel, objects or infrastructure by blast wind. Tertiary injury is variety of injuries to all organ systems. Traumatic amputation is typically included within this category...

WEAPON EFFECTS Ballistics The ability to manage conflict injuries relies on an under - standing of the underlying mechanism of wounding, which - is likely to be di ff erent from that in civilian trauma. As stated, while ballistic injuries are no longer the ...

Ankle ( Figure 35.37 ) /uni25CF Dorsiflexion . Test dorsiflexion with the knee both flexed and extended. If restriction is greater with the knee extended than flexed, the contracture is principally in the gastrocnemius. Restriction that is equal in all knee posi ...

Ankle stability Trauma to the ankle is a common cause of instability . Accurate assessment may be di ffi cult in the acute setting because of pain. /uni25CF Anterior draw test . With the foot resting over the bed, hold the heel with one hand and the front of ...

Anterior cruciate ligament The most sensitive test for evaluation of the ACL is the Lachman test. /uni25CF The Lachman test ( Figure 35.32 ). Flex the knee to 15–30° and pull the proximal tibia gently forwards. Exces - sive laxity may indicate rupture of the...