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The Journal of Bone and Joint Surgery (American) 84:1221-1234 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Current Concepts Review

Blast and Fragment Injuries of the Musculoskeletal System

Dana C. Covey, Captain, Medical Corps, United States Navy

Investigation performed at the Department of Orthopaedic Surgery, United States Naval Hospital Okinawa, Japan, and the Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland

Captain Dana C. Covey, Medical Corps, United States Navy Department of Orthopaedic Surgery, United States Naval Hospital Okinawa, PSC 482, Box 2563, FPO AP 96362-2563. E-mail address: coveydc{at}oki10.med.navy.mil Please address requests for reprints to D.C. Covey.

In support of the research or preparation of this manuscript, the author received grants or outside funding from the Chairman of the Joint Chiefs of Staff Award for Excellence in Military Medicine and from the Zachary and Elizabeth Fisher Foundation. The author did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the author is affiliated or associated.

The views expressed in this paper are those of the author and do not reflect the official policy or position of the Department of the Navy, the Department of Defense, or the United States Government.

Abstract

Blast and fragment injuries of the musculoskeletal system are the most frequently encountered wounds in modern warfare.

Most injuries to the musculoskeletal system involve so-called secondary blast injuries in which casing fragments and other debris become flying projectiles.

Nonoperative treatment of selected wounds caused by small-fragment debris has been successful but remains controversial.

Successful surgical treatment depends on meticulous wound débridement, with excision of nonviable tissue and foreign material likely to cause infection; adequate drainage; and delayed closure.

Advanced internal fixation techniques used in modern trauma centers to treat predominantly blunt trauma may not be appropriate for care of orthopaedic war wounds in a field setting.


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