Penetrating and orthopaedic trauma from blast versus gunshots caused by terrorism: Israel's national experience

Objective: Evaluation of the demographics, features, and outcomes of musculoskeletal injury patterns caused by terrorism in the civil setting and comparing injuries from explosions with gunshot injuries. Design: Retrospective cohort analysis of a prospective database. Setting: National trauma registry consisting of all the six Level I and four Level II trauma centers. Patients: A total of 1245 casualties with terror-related musculoskeletal trauma. Five hundred fifty-one had high-velocity gunshot wound and 694 blast wounded (BW) caused by explosion. Main Outcome Measurements: Demographic and injury data analyzed for age, gender, New Injury Severity Score, and associated injuries. Outcome of were analyzed according to length of hospital stay, intensive care unit stay, surgical procedures, and mortality. Results: Severe injuries (New Injury Severity Score 16 or greater) were more common in the BW group (P < 0.01). In the BW group, a significantly higher proportion of casualties had associated injuries (73% versus 43%), intensive care unit care, longer length of stay, and mortality. Orthopaedic injuries were similar among the two groups with more open extremity fractures in the gunshot wound group and less significant injuries in the BW group. With casualties matched to the same New Injury Severity Score groups, the ones with the musculoskeletal injuries had longer hospitalization than those without. Conclusions: Musculoskeletal injury caused by blast is associated with multiple penetrating injuries, differing from more "conventional" penetrating trauma such as caused by gunshot injuries. Although the treatment of specific injuries caused by both mechanisms is essentially similar, the systemic effect of the blast must be taken into consideration in anticipation of an increased overall injury severity.