Dismounted pelvic blast injury: mechanisms of injury, associated injuries and mitigation strategies
File(s)
Author(s)
Rankin, Iain Alexander
Type
Thesis
Abstract
Explosive blast has been the most common cause of wounding and death in recent military conflicts. Where blast resulted in injury to the pelvis of an on-foot casualty, the mortality rate was high. The mechanism of injury by which this occurs is not known. The research presented in this thesis sought to understand the pattern and mechanism of this devastating injury, in order to develop protective strategies.
An analysis was performed of battlefield data which identified pelvic vascular injury as the cause of death in these casualties. Furthermore, it showed displaced pelvic fractures, perineal wounding, and traumatic amputation to be associated with this lethal injury.
Hypothesised mechanisms of injury were investigated using cadaveric animal models of blast. These investigations showed rapid outward movement of the lower limbs (‘limb flail’), caused by the blast wave, to be necessary for displaced pelvic fractures with vascular injury to occur. High velocity sand ejecta, as propagated by blast (‘sand blast’), showed correlation with increasing velocity and injury patterns of worsening severity across the trauma range. This included the associated injuries of perineal wounding and traumatic amputation. Following this research, lower limb flail and high velocity sand blast were identified as the mechanisms of injury of blast to the pelvis.
Novel pelvic protective equipment was developed to limit lower limb flail in a cadaveric animal model of blast. This resulted in a reduction of pelvic fractures and elimination of pelvic vascular injury. Protective silk shorts were subsequently examined in a human cadaveric model and shown to markedly reduce the severity of injury from high velocity sand blast.
Implementation of the protective strategies described in this thesis is suggested to reduce the severe injury burden and mortality rate associated with blast injury to the pelvis.
An analysis was performed of battlefield data which identified pelvic vascular injury as the cause of death in these casualties. Furthermore, it showed displaced pelvic fractures, perineal wounding, and traumatic amputation to be associated with this lethal injury.
Hypothesised mechanisms of injury were investigated using cadaveric animal models of blast. These investigations showed rapid outward movement of the lower limbs (‘limb flail’), caused by the blast wave, to be necessary for displaced pelvic fractures with vascular injury to occur. High velocity sand ejecta, as propagated by blast (‘sand blast’), showed correlation with increasing velocity and injury patterns of worsening severity across the trauma range. This included the associated injuries of perineal wounding and traumatic amputation. Following this research, lower limb flail and high velocity sand blast were identified as the mechanisms of injury of blast to the pelvis.
Novel pelvic protective equipment was developed to limit lower limb flail in a cadaveric animal model of blast. This resulted in a reduction of pelvic fractures and elimination of pelvic vascular injury. Protective silk shorts were subsequently examined in a human cadaveric model and shown to markedly reduce the severity of injury from high velocity sand blast.
Implementation of the protective strategies described in this thesis is suggested to reduce the severe injury burden and mortality rate associated with blast injury to the pelvis.
Version
Open Access
Date Issued
2020-12
Date Awarded
2021-03
Copyright Statement
Creative Commons Attribution NonCommercial Licence
License URL
Advisor
Masouros, Spyridon
Sponsor
Royal British Legion
Publisher Department
Bioengineering
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)