Bennett, Philippa Mary (2020) Consequences, challenges and future solutions in combat lower limb trauma. PhD thesis, University of Warwick.

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Abstract

The British Military was engaged in over a decade of conflict during the wars of Iraq
and Afghanistan. The enemy’s use of Improvised Explosive Devices (IEDs) saw
traumatic lower limb amputation representing one end of the spectrum of injury
severity, with multiple fractures of the femur, tibia and hindfoot also seen.
The surgical approach to both traumatically amputated and severely injured limbs
evolved over the course of the conflicts. Amputations were debrided within the
zone of injury in an attempt to preserve limb length, an approach which required
multiple surgical episodes. Patients whose fractures were deemed suitable for
attempts at limb reconstruction underwent multiple orthopaedic and
reconstructive procedures with the assumption that they would have superior
functional outcomes than if they underwent amputation.
These changing surgical strategies and a realisation of the uncertainty of the
optimum approach presented a “could versus should” paradigm of limb
reconstruction. Just because it was thought a limb could be reconstructed, should it
be? What would give patients the optimal functional outcome? Limb
reconstruction, or amputation?
To answer this question my research characterised the patterns of lower limb
injuries seen following combat, presented functional outcomes, identified causes
for poor outcomes and systematically investigated potential solutions. This
research challenges the accepted definition of “success” following severe hindfoot
trauma, and establishes the specific injury patterns that are associated with a worse
functional outcome than those patients undergoing unilateral lower limb
amputation.
My analysis of lower limb combat injuries revealed that rates of fracture non-union
in military patients are higher than those seen following similar civilian injuries.
Having published the very first systematic review into preclinical therapies for
fracture non-union, the research highlights the alarmingly poor state of research,
and calls for international collaboration and standards to more rapidly identify
therapies that may successfully treat this devastating condition.

Item Type:	Thesis (PhD)
Subjects:	R Medicine > RD Surgery
Library of Congress Subject Headings (LCSH):	Leg -- Amputation, Foot -- Amputation, Leg -- Surgery, War wounds -- Treatment, War wounds -- Surgery
Official Date:	January 2020
Dates:	Date Event January 2020 Submitted
Institution:	University of Warwick
Theses Department:	Warwick Medical School
Thesis Type:	PhD
Publication Status:	Unpublished
Supervisor(s)/Advisor:	Ellard, David R., Wall, Peter D. H.
Extent:	156 leaves : illustrations (some colour, some black and white), charts
Language:	eng

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