La cheville et le pied: C'est grave AUSSI

Outcomes of IED Foot and Ankle Blast Injuries

Ramasamy A et All. J Bone Joint Surg Am. 2013;95:e25(1-7)

Background: Improvements in protection and medical treatments have resulted in increasing numbers of modernwarfare casualties surviving with complex lower-extremity injuries. To our knowledge, there has been no prior analysis of foot and ankle blast injuries as a result of improvised explosive devices (IEDs). The aims of this study were to report the pattern of injury and determine which factors are associated with a poor clinical outcome.

Methods: U.K. service personnel who had sustained lower leg injuries following an under-vehicle explosion from January 2006 to December 2008 were identified with the use of a prospective trauma registry. Patient demographics, injury severity, the nature of the lower leg injury, and the type of clinical management were recorded. Clinical end points were determined by (1) the need for amputation and (2) ongoing clinical symptoms.

Results: Sixty-three U.K. service personnel (eighty-nine injured limbs) with lower leg injuries from an explosion were identified. Fifty-one percent of the casualties sustained multisegmental injuries to the foot and ankle. Twenty-six legs (29%) required amputation, with six of them amputated because of chronic pain eighteen months following injury. Regression analysis revealed that hindfoot injuries, open fractures, and vascular injuries were independent predictors ofamputation. At the time of final follow-up, sixty-six (74%) of the injured limbs had persisting symptoms related to the injury,and only nine (14%) of the service members were fit to return to their preinjury duties.

Conclusions: This study demonstrates that foot and ankle injuries from IEDs are associated with a high amputation rateand frequently with a poor clinical outcome. Although not life-threatening, they remain a source of long-term morbidity in an active population

 

On insiste beaucoup sur la gravité des lésions des membres inférieurs car elles sont sources d'hémorragies graves. Cette gravité est aussi fonctionnelle. Les auteurs de ce document insistent sur la fréquence de l'atteinte de la cheville et du pied (plus d'une fois sur 2), sur la gravité de l'atteinte de la cheville et de l'arrière pied et de la fréquence des amputations près d'une fois sur 3