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Imaging in paediatric blast injuries: musculoskeletal injuries in the Syrian Civil War
I Korkmaz1, M E Çelikkaya2, A Atıcı2
1Department of Radiology, Faculty of Medicine, Hatay Mustafa Kemal University, Antakya, Hatay Province, Turkey.
Insights
Pediatric blast injuries show distinct patterns, with primary blast injuries frequently causing skull fractures and amputations. Radiologists must recognize these patterns for effective mass casualty triage.
Area of Science:
- Pediatric Radiology
- Trauma Surgery
- Blast Injury Research
Background:
- Explosive events cause severe injuries in children, necessitating a clear understanding of injury patterns.
- Radiological assessment is crucial for diagnosing musculoskeletal and organ damage in pediatric blast victims.
Purpose of the Study:
- To analyze radiological findings in children with blast-related musculoskeletal and organ injuries.
- To differentiate injury types and frequencies based on blast mechanisms.
- To highlight radiology's role in managing pediatric war injuries.
Main Methods:
- Retrospective review of 74 children with bomb explosion injuries.
- Evaluation of radiographs and CT scans for musculoskeletal and organ injuries.
- Recording of initial pediatric trauma scores.
Main Results:
- Skull fractures were most common in primary blast injury (PBI), while lower extremity fractures dominated other groups.
- Amputations occurred in 31% of PBI patients, but not in secondary blast injury (SBI) patients.
- High incidence of pneumothorax (79.3%) and pulmonary contusion (59.4%) in PBI; skull fractures accompanied brain and pulmonary trauma.
Conclusions:
- Pediatric musculoskeletal injury patterns differ significantly with blast injury type.
- Radiologists require knowledge of blast injury mechanisms and spectrum for triage.
- Understanding these patterns is vital for effective management of pediatric trauma in conflict zones.
Aim:
To examine the radiological images of children with musculoskeletal injuries and accompanying organ injuries caused by explosions to determine the differences and frequency of injury types and to emphasise the importance of radiology in war injuries.
Materials And Methods:
Seventy-four children with injuries caused by bomb explosions were included in the study. The paediatric trauma scores evaluated in the emergency department on the first admission were recorded. All radiographs and computed tomography (CT) images were evaluated for musculoskeletal injuries and accompanying organ injuries.
Results:
The highest incidence of fracture in the primary blast injury (PBI) group was skull fracture in 15 (62.5%) patients (p=0.01) and fractures in the other groups were most common in the lower extremities. Amputation was observed in nine (31%) patients in the PBI group (p=0.003); however, there were no patients with amputations in the secondary blast injury (SBI) group (p=0.002). The frequency of pneumothorax (79.3%) and pulmonary contusion (59.4%) was high in the PBI group (p<0.001 and p=0.004, respectively). Skull fractures were observed in 15 (88.2%) of 17 patients with brain injury (p<0.001), and skull fractures were the most common fracture site accompanying pulmonary trauma. The average paediatric trauma score of individuals exposed to shrapnel was found to be high (p<0.001).
Conclusion:
Because paediatric musculoskeletal injuries vary with the type of blast injury and severe trauma can occur in children due to blast effects, radiologists who triage mass injuries should understand the effects of blast injury patterns and the spectrum of injury.
