Missile injuries of the limbs: an Iraqi perspective

Missiles include pistol or rifle bullets, shell fragments, land mines, and grenades. Medium- and high-velocity missiles produce damage by laceration and crushing, shock waves, and cavitational effects. Low-velocity missiles produce damage by laceration and crushing only. Land mine injuries cause damage by the primary blast effect, secondarily by fragments, and thirdly by the effect induced by whole-body propulsion and by burns. Severity of injuries should be graded according to the degree of soft-tissue damage, bone defect or comminution, and vascular or neural injury. Among other factors, successful management of these injuries requires prompt and vigorous resuscitation, careful wound inspection, aggressive exploration, liberal débridement, and prompt removal of fragments. In addition, in these circumstances, one must stay alert for overlooked injuries and be aware of associated psychological trauma.