Abstract

Pelvic blast injury is one of the most severe patterns of injury to be sustained by casualties of explosions. We have previously identified the mechanism of injury in a shock tube-mediated murine model, linking outward flail of the lower limbs to unstable pelvic fractures and vascular injury. As current military pelvic protection does not protect against lower limb flail, in this study we have utilized the same murine model to investigate the potential of novel pelvic protection to reduce injury severity. Fifty cadaveric mice underwent shock-tube blast testing and subsequent injury analysis. Pelvic protection limiting lower limb flail resulted in a reduction of pelvic fracture incidence from both front-on (relative risk (RR) 0.5, 95% confidence intervals (CIs) 0.3–0.9, p < 0.01) and under-body (RR 0.3, 95% CI 0.1–0.8 p < 0.01) blast, with elimination of vascular injury in both groups (p < 0.001). In contrast, pelvic protection, which did not limit flail, had no effect on fracture incidence compared to the control group and was only associated with a minimal reduction in vascular injury (RR 0.6, 95% CI 0.4–1.0, p < 0.05). This study has utilized a novel strategy to provide proof of concept for the use of pelvic protection, which limits limb flail to mitigate the effects of pelvic blast injury.

References

References
1.
Edwards
,
D. S.
,
McMenemy
,
L.
,
Stapley
,
S. A.
,
Patel
,
H. D. L.
, and
Clasper
,
J. C.
,
2016
, “
40 Years of Terrorist Bombings—A Meta-Analysis of the Casualty and Injury Profile
,”
Injury
,
47
(
3
), pp.
646
652
.10.1016/j.injury.2015.12.021
2.
Mcfate
,
M.
, and
Moreno
,
J. L.
,
2005
, “
Iraq: The Social Context of IEDs
,”
Mil. Rev.
,
25
, pp.
37
40
.https://apps.dtic.mil/dtic/tr/fulltext/u2/a486807.pdf
3.
Russell
,
R.
,
Hunt
,
N.
, and
Delaney
,
R.
,
2014
, “
The Mortality Peer Review Panel: A Report on the Deaths on Operations of UK Service Personnel 2002-2013
,”
J. R. Army Med. Corps
,
160
(
2
), pp.
150
154
.10.1136/jramc-2013-000215
4.
Webster
,
C.
, and
Clasper
,
J.
,
2016
, “
Pelvic Blast Injury
,”
Blast Injury Science and Engineering
,
A.
Bull
,
J.
Clasper
, and
P.
Mahoney
, eds.,
Springer International Publishing
,
Switzerland
, pp.
255
259
.
5.
Webster
,
C. E.
,
Clasper
,
J.
,
Stinner
,
D. J.
,
Eliahoo
,
J.
, and
Masouros
,
S. D.
,
2018
, “
Characterization of Lower Extremity Blast Injury
,”
Mil. Med.
,
183
(
9–10
), pp.
e448
e453
.10.1093/milmed/usx126
6.
Rankin
,
I. A.
,
Webster
,
C. E.
,
Gibb
,
I.
,
Clasper
,
J. C.
, and
Masouros
,
S. D.
,
2020
, “
Pelvic Injury Patterns in Blast
,”
J. Trauma Acute Care Surg.
,
88
(
6
), pp.
832
838
.10.1097/TA.0000000000002659
7.
Rankin
,
I. A.
,
Nguyen
,
T. T.
,
Carpanen
,
D.
,
Clasper
,
J. C.
, and
Masouros
,
S. D.
,
2019
, “
Restricting Lower Limb Flail is Key to Preventing Fatal Pelvic Blast Injury
,”
Ann. Biomed. Eng.
,
47
(
11
), pp.
2232
2240
.10.1007/s10439-019-02296-z
8.
Lewis
,
E. A.
,
Pigott
,
M. A.
,
Randall
,
A.
, and
Hepper
,
A. E.
,
2013
, “
The Development and Introduction of Ballistic Protection of the External Genitalia and Perineum
,”
J. R. Army Med. Corps
,
159
(
Suppl. 1
), pp.
i15
i17
.10.1136/jramc-2013-000026
9.
Oh
,
J. S.
,
Do
,
N. V.
,
Clouser
,
M.
,
Galarneau
,
M.
,
Philips
,
J.
,
Katschke
,
A.
,
Clasper
,
J.
, and
Kuncir
,
E. J.
,
2015
, “
Effectiveness of the Combat Pelvic Protection System in the Prevention of Genital and Urinary Tract Injuries: An Observational Study
,”
J. Trauma Acute Care Surg.
,
79
(
4
), pp.
S193
S196
.10.1097/TA.0000000000000735
10.
Breeze
,
J.
,
Allanson-Bailey
,
L. S.
,
Hepper
,
A. E.
,
Midwinter
,
M. J.
, and
Johno
,
M.
,
2015
, “
Demonstrating the Effectiveness of Body Armour: A Pilot Prospective Computerised Surface Wound Mapping Trial Performed at the Role 3 Hospital in Afghanistan
,”
J. R. Army Med. Corps
,
161
(
1
), pp.
36
41
.10.1136/jramc-2014-000249
11.
Gordon
,
W.
,
Talbot
,
M.
,
Fleming
,
M.
,
Shero
,
J.
,
Potter
,
B.
, and
Stockinger
,
Z. T.
,
2018
, “
High Bilateral Amputations and Dismounted Complex Blast Injury (DCBI)
,”
Mil. Med.
,
183
(
Suppl._2
), pp.
118
122
.10.1093/milmed/usy082
12.
Oh
,
J. S.
,
Tubb
,
C. C.
,
Poepping
,
T. P.
,
Ryan
,
P.
,
Clasper
,
J. C.
,
Katschke
,
A. R.
,
Tuman
,
C.
, and
Murray
,
M. J.
,
2016
, “
Dismounted Blast Injuries in Patients Treated at a Role 3 Military Hospital in Afghanistan: Patterns of Injury and Mortality
,”
Mil. Med.
,
181
(
9
), pp.
1069
1074
.10.7205/MILMED-D-15-00264
13.
Webster
,
C. E.
,
Clasper
,
J.
,
Gibb
,
I.
, and
Masouros
,
S. D.
,
2018
, “
Environment at the Time of Injury Determines Injury Patterns in Pelvic Blast
,”
J. R. Army Med. Corps
,
165
, pp.
15
17
.10.1136/jramc-2018-000977
14.
Nguyen
,
T.-T. N.
,
Wilgeroth
,
J. M.
, and
Proud
,
W. G.
,
2014
, “
Controlling Blast Wave Generation in a Shock Tube for Biological Applications
,”
J. Phys. Conf. Ser.
,
500
(
14
), p.
142025
.10.1088/1742-6596/500/14/142025
15.
Tile
,
M.
,
1996
, “
Acute Pelvic Fractures: I. Causation and Classification
,”
J. Am. Acad. Orthop. Surg.
,
4
(
3
), pp.
143
151
.10.5435/00124635-199605000-00004
16.
Patel
,
J. A.
,
White
,
J. M.
,
White
,
P. W.
,
Rich
,
N. M.
, and
Rasmussen
,
T. E.
,
2018
, “
A Contemporary, 7-Year Analysis of Vascular Injury From the War in Afghanistan
,”
J. Vasc. Surg.
,
68
(
6
), pp.
1872
1879
.10.1016/j.jvs.2018.04.038
17.
Rankin
,
I. A.
,
Ramasamy
,
A.
, and
Cooper
,
J.
,
2019
, “
Blast Injuries to the Pelvis: Essential Lessons Learned
,”
J. Trauma Orthop.
,
7
(
4
), pp.
52
54
.https://www.boa.ac.uk/uploads/assets/4f6c45a5-0e01-40d5-ab37f9552892bddb/blast-injuries-to-the-pelvis-essential-lessons-learned.pdf
18.
Zhang
,
Y.
,
2003
, “
Animal Models of Inflammatory Spinal and Sacroiliac Joint Diseases
,”
Rheum. Dis. Clin. North Am.
,
29
(
3
), pp.
631
645
.10.1016/S0889-857X(03)00049-8
19.
Treuting
,
P. M.
,
Dintzis
,
S. M.
, and
Montine
,
K. S.
,
2018
,
Comparative Anatomy and Histology: A Mouse, Rat, and Human Atlas
, Elsevier, Amsterdam, The Netherlands.
20.
Hayer
,
S.
,
Niederreiter
,
B.
,
Nagelreiter
,
I.
,
Smolen
,
J.
, and
Redlich
,
K.
,
2010
, “
Interleukin 6 is Not a Crucial Regulator in an Animal Model of Tumour Necrosis Factor-Mediated Bilateral Sacroiliitis
,”
Ann. Rheum. Dis.
,
69
(
7
), pp.
1403
1406
.10.1136/ard.2010.129148
21.
Redlich
,
K.
,
Görtz
,
B.
,
Hayer
,
S.
,
Zwerina
,
J.
,
Kollias
,
G.
,
Steiner
,
G.
,
Smolen
,
J. S.
, and
Schett
,
G.
,
2004
, “
Overexpression of Tumor Necrosis Factor Causes Bilateral Sacroiliitis
,”
Arthritis Rheum.
,
50
(
3
), pp.
1001
1005
.10.1002/art.20194
22.
Shi
,
S.
,
Ciurli
,
C.
,
Cartman
,
A.
,
Pidoux
,
I.
,
Poole
,
A. R.
, and
Zhang
,
Y.
,
2003
, “
Experimental Immunity to the G1 Domain of the Proteoglycan Versican Induces Spondylitis and Sacroiliitis, of a Kind Seen in Human Spondylarthropathies
,”
Arthritis Rheum.
,
48
(
10
), pp.
2903
2915
.10.1002/art.11270
23.
Uderhardt
,
S.
,
Diarra
,
D.
,
Katzenbeisser
,
J.
,
David
,
J.-P.
,
Zwerina
,
J.
,
Richards
,
W.
,
Kronke
,
G.
, and
Schett
,
G.
,
2010
, “
Blockade of Dickkopf (DKK)-1 Induces Fusion of Sacroiliac Joints
,”
Ann. Rheum. Dis.
,
69
(
3
), pp.
592
597
.10.1136/ard.2008.102046
24.
Bowen
,
I.
,
Fletcher
,
E.
, and
Richmond
,
D.
,
1968
, “
Estimate of Man's Tolerance to the Direct Effects of Air Blast
,”
Def. At. Support Agency, Department of Defense U.S. Gov
.,
Washington, DC
,
Report No. DASA-2113
.10.21236/ad0693105
25.
Richmond
,
D. R.
,
Goldzien
,
V. C.
,
Clare
,
V. R.
,
Pratt
,
D. E.
,
Sherping
,
F.
,
Sanchez
,
R. T.
,
Fischer
,
C. C.
, and
White
,
C. S.
,
1962
, “
The Biologic Response to Overpressure—III: Mortality in Small Animals Exposed in a Shock Tube to Sharprising Overpressures of 3 to 4 Msec Duration
,”
Aerosp. Med.
,
33
, pp.
1
27
.https://pubmed.ncbi.nlm.nih.gov/14492014/
26.
Chandra
,
N.
,
Ganpule
,
S.
,
Kleinschmit
,
N. N.
,
Feng
,
R.
,
Holmberg
,
A. D.
,
Sundaramurthy
,
A.
,
Selvan
,
V.
, and
Alai
,
A.
,
2012
, “
Evolution of Blast Wave Profiles in Simulated Air Blasts: Experiment and Computational Modeling
,”
Shock Waves
,
22
(
5
), pp.
403
415
.10.1007/s00193-012-0399-2
27.
Cullis
,
I. G.
,
2001
, “
Blast Waves and How They Interact With Structures
,”
J R Army Med Corps
,
147
(
1
), pp.
16
26
.10.1136/jramc-147-01-02
28.
Mellor
,
S. G.
, and
Cooper
,
G. J.
,
1989
, “
Analysis of 828 Servicemen Killed or Injured by Explosion in Northern Ireland 1970–84: The Hostile Action Casualty System
,”
Br. J. Surg.
,
76
(
10
), pp.
1006
1010
.10.1002/bjs.1800761006
29.
de Candole
,
C. A.
,
1967
, “
Blast Injury
,”
Can. Med. Assoc. J.
,
96
(
4
), pp.
207
214
. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1936899/
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