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Isolated limb fractures – the underestimated injury in the Israeli Defence Forces (IDF)

  • Author Footnotes
    1 contributed equally to the writing and are co-first authors
    Yuval Ran
    Correspondence
    Corresponding author at: Tel Aviv Sourasky Medical Center, Shraga Refaeli 20, app 27, 4906422 Petah Tikva, Israel.
    Footnotes
    1 contributed equally to the writing and are co-first authors
    Affiliations
    The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel

    Tel-Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Author Footnotes
    1 contributed equally to the writing and are co-first authors
    Ilan Mitchnik
    Footnotes
    1 contributed equally to the writing and are co-first authors
    Affiliations
    The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
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  • Sami Gendler
    Affiliations
    The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
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  • Guy Avital
    Affiliations
    The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel

    Division of Anesthesia, Intensive Care and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, 6423906 Tel-Aviv, Israel
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  • Irina Radomislensky
    Affiliations
    The National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel-Hashomer, Israel
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  • Moran Bodas
    Affiliations
    The National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel-Hashomer, Israel

    Department of Emergency Management and Disaster Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv-Yafo, Israel
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  • Amit Benady
    Affiliations
    Tel-Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Levin Center for 3D printing and Surgical Innovation, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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  • Avi Benov
    Affiliations
    The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel

    The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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  • Author Footnotes
    2 contributed equally to the manuscript and are co-last authors
    Ofer Almog
    Footnotes
    2 contributed equally to the manuscript and are co-last authors
    Affiliations
    The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
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  • Author Footnotes
    2 contributed equally to the manuscript and are co-last authors
    Jacob Chen
    Footnotes
    2 contributed equally to the manuscript and are co-last authors
    Affiliations
    The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel

    Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
    Search for articles by this author
  • Author Footnotes
    1 contributed equally to the writing and are co-first authors
    2 contributed equally to the manuscript and are co-last authors
Published:November 11, 2022DOI:https://doi.org/10.1016/j.injury.2022.11.014

      Abstract

      Introduction

      Musculoskeletal injuries dominate warfare-related trauma and differ from civilian settings in higher hospitalization costs, morbidity, and mortality. Partly due to introduction of personal protective equipment in the Israel Defence Force (IDF) to minimize head and torso injuries while the extremities remained unprotected. This study describes military extremity injury patterns, prehospital treatment and injury sequela regarding return-to-duty and disability compensation.

      Methods

      This retrospective study examined cases of battle and non-battle trauma casualties treated by the IDF Medical Corps from 2013 to 2020. Data from the IDF Trauma Registry (IDF-TR) was merged with The Israeli National Trauma Registry (INTR). Cases with high morbidity discharged from military service were compared with lower morbidity patients who returned to active duty service.

      Results

      Out of 1360 injured soldiers, 280 (20.6%) were found to have isolated limb fractures (ILFs). High morbidity casualties had more open fractures (63% vs. 42%) and higher involvement of lower extremities (79% vs. 58%) (p < 0.001), higher rates of tourniquets use (28% compared to 9%, p < 0.001), external fixation (34% vs. 19%, p < 0.001) and amputations (9% vs. 1%, p = 0.003), required more rehabilitation (34% vs. 7%, p < 0.001), and had 46% medical disabilities compared to 24% with low morbidity (p < 0.001).

      Conclusions

      ILFs are associated with significant morbidity and disability. High morbidity is associated with high energy, scar-producing, lower-extremity open fractured limbs treated by tourniquets. Future studies should evaluate whether junctional or extremity protective gear is combat feasible and whether introducing Clinical Practice Guidelines to manage suspected limb fractures can decrease morbidity rates and improve return to duty.

      Keywords

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