Table 1 Patient characteristics, injury, diagnostic and treatment data
From: Periarticular blast wounds without fracture a prospective case series
Case | Age | Mechanism | Triage | Exam | Radiographs | Wounds | Diagnostic procedures | OR Procedures | Other injuries | AIS | NISS | Disposition |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | 24 | IED | Delayed transfer | Large effusion with painful R knee | Air-fluid level R knee, no fx | 10 cm wound R knee | R knee hemarthrosis aspiration, positive saline load test | I&D, wound exploration, extended traumatic arthrotomy; irrigation, capsular closure | No other injuries R knee | 2 | 4 | Returned home |
2 | 20 | Mortar | Immediate | L ulnar nerve paresthesias | No intra-articular fragments, no effusion, no fx | 2 Medial L elbow wounds (largest 2.5 cm) within 4 cm of medial epicondyle | None | I&D L elbow wounds, negative aspiration, and reverse arthrocentesis | No other injuries L elbow | 2 | 4 | Medevac Level 3 |
3 | 21 | IED | Immediate | L ulnar nerve paresthesias | Metal fragment 8 cm distal to L elbow, no evidence of effusion, no fx | 2 × 1 cm medial elbow wound 3 cm proximal to medial epicondyle | None | I&D of wounds, extension traumatic arthrotomy, capsular closure after irrigation | No other injuries L elbow | 2 | 4 | Medevac Level 3 |
4 | 21 | Exploding rounds | Immediate | Large effusion, painful L knee | Multiple fragments L knee, none intra-articular, no fx | Multiple small wounds < 1–2 mm | Preoperative aspiration hemarthrosis | Arthrotomy, joint irrigation, primary closure | No other injuries L knee | 2 | 4 | RTD 3 weeks post injury |
5 | 27 | IED | Delayed | L knee pain | No retained fragments, no fracture | 4 cm lateral wound at level of mid-patella L knee | Hemarthrosis aspirated L knee, positive saline load test | I&D, wound exploration, L knee arthrotomy, capsular closure after joint irrigation; delayed wound closure | R forearm soft tissue wound 2.5 cm w/o fracture | R forearm (1), L knee (2) | 5 | Medevac US |
6 | 30 | IED | Immediate | R hand pain | Metal fragment in 2nd MCP joint R hand, no fracture | 1 cm wound dorsal index MCP joint | None | Exploratory laparotomy, I&D, wound exploration, joint capsule penetrated, arthrotomy extended, capsule closed after irrigation | Liver injury, soft tissue wounds R arm | Liver (3), R arm (1), hand (1) | 11 | Medevac Level 3 |
7 | 22 | IED | Immediate | Diffuse pain consistent with injury | Metal fragment 5th MTP joint L foot, no fracture | 1 cm lateral wound over 5th MTP joint | None | I&D wounds, traumatic arthrotomy extended, capsule closed after joint irrigated, delayed closure | Liver injury; soft tissue wounds R arm | Liver (2), R leg (1), R foot (1) | 6 | RTD 2 weeks post injury |
8 | 25 | VBIED | Immediate | Pain consistent with L knee injury | No retained fragments, effusion or fx on XR | 3.5 cm lateral wound at proximal patella L knee | None | I&D wounds, joint capsule penetration, extension of arthrotomy, capsular closure after joint irrigation | No other injuries L knee | 2 | 4 | Medevac Level 3 |
9 | 20 | Grenade | Minimal | L elbow joint irritability | Retained fragment intra-articular L elbow, no fx | 2 mm posterior lateral wound | None | I&D L elbow wounds, removal intra-articular metal fragment, closure 1 cm joint capsule penetration after irrigation | No other injuries L elbow | 2 | 4 | Medevac Level 3 |
10 | 20 | IED | Minimal | R knee peroneal nerve palsy, no effusion | Metal fragment, lateral to joint, no fx | 1 × 2 cm wound, just proximal to fibular head, dense motor and sensory peroneal nerve palsy | None | Negative R knee aspiration, large, retained metal fragment, wound exploration, longitudinal rent in otherwise intact peroneal nerve, wounds irrigated, extension closed | No other injuries R knee | 2 | 4 | Medevac Level 3 |
11 | 24 | Grenade | Minimal | Pain L ankle joint | Few retained metal fragments anterior ankle, suspicious for joint penetration | 1 × 1 cm ant-lat and 1 × 2 cm ant-med | None | I&D, wound exploration, anterior capsule rent 2 cm, joint irrigated and closed, wound extension closed | Superficial wounds both shoulders | AIS = (1), left leg (1) left ankle = (2) moderate | 5 | Medevac Level 3 |
12 | 22 | IED | Delayed | No L knee effusion, minimal pain, near full ROM | Retained metal fragment level of superior pole patella, no fx | 1 mm wound superior pole L patella | None | IV antibiotics | Small fragment wounds | R leg AIS = (1)minor; L leg AIS = (1) minor; R knee AIS = (1) minor | 2 | RTD 2 weeks post injury |