Traumatismes par effet blast des membres inférieurs : Etude de 86 blessés par explosion de mines.*
Par A.M. LAZAR et M.K. LARBAOUI. Algérie
Ahmed Mohamed LAZAR
Lt.-Colonel LAZAR Ahmed Mohamed. FONCTION ACTUELLE Maître de conférences classe « A » Hospitalo-Universitaire en chirurgie orthopédique. Chef de l’unité d’arthroscopie du service de chirurgie orthopédique de l’Hôpital Central de l’Armée Alger Algérie. DIPLÔMES • Doctorat en médecine générale : 1997. • Diplôme des études médicales spéciales en chirurgie orthopédique : 2003. • Maîtrise en chirurgie orthopédique : 2005. • Doctorat en science médicale : 2014. • Professeur agrégé : 2016. DOMAINES D’INTÉRÊT arthroscopie, chirurgie du genou, traumatologie balistique.
Lower Limb Injuries Due to a Blast Effect: A Study of 86 Casualties by Mine Explosion.
Introduction: Lower limb blast injuries, caused by improvised explosive devices (IEDs), have become the signature of terrorists in Algeria since the early 1990’s. It is a special clinical entity due to its gravity, its special care and its social repercussions. Materials and methods: We studied a sample of 86 mine casualties, that were received in our emergency department. Among which we counted 90 lower limb blast injuries (4 casualties suffered bilateral lesions). The causative agent was an anti-personnel mine with a blast effect. All the wounded were male with an average age of 21 years. The average reception time was 3 hours and 30 minutes after the explosion. Results: Emergency procedures were performed: resuscitation, prevention of infection, pain control, wound excision. Early mortality involved five wounded, including 3 severely burned. The treatment was as conservative as possible. The wounded have benefited from a therapeutic chain up to the apparatus. These traumas caused 78 open injuries(87%) and 12 closed injuries (13%). We noticed associated lesions very frequently: multiple lesions in 90% of the cases, long limb bones fractures in 9% , ear blast in 40% , fractures of the spine in 3 cases , burn wounds in 25%. Observations ranged from a single injury to polytrauma. The closure was done per premium in 12% of the cases. In most cases though, it was preferable to close the residual limb in two stages. There were 92% trans-tibial amputations for 8% trans-femoral amputations. We registered 15% of infections by anaerobic (telluric) bacteria that required block recoveries with sometimes upper amputations. Discussion: Blast trauma is the greatest cause of injuries in current conflicts. A shock wave secondary to the sudden rise in pressure is at the origin of the primary lesions or blast lesions. Other lesions by explosion can be classified into secondary lesions (splinters), tertiary (projection) and quaternary lesions (burns, crushing, smoke ...). Fifth order lesions have recently been described (hyper inflammation). An explosion rarely causes a single wound, whether in military or civilian environments. The management of the victims is based on a rapid sorting of the influx of victims in a first time and then a trauma care similar to that is done in the case of usual penetrating or closed traumatisms. Conclusion: The management of the victims of accidents by blast effect does not stop at the surgery level. This is often underestimated and entrusted to the young surgeons, which will lead to defective stumps that cannot be used for prosthesis. Therefore surgery needs to be repeated several times. In addition to the surgeon, the care provided by a psychologist is paramount. VOL. 90/3
MOTS-CLÉS : Pied de mine, Effet blast, Amputation post-traumatique. KEYWORDS: Lower limb blast injuries, Blast effect, Traumatic amputations.
International Review of the Armed Forces Medical Services
Revue Internationale des Services de Santé des Forces Armées