Evaluation of combat-related orthopaedic injuries: a comparative study of two military campaigns

Traumatic orthopaedic injuries are common in warzones and are associated with a high complication rate. Our aim is to compare and characterise orthopaedic injuries sustained by the service members of the Israel Defense Forces in combat during two military campaigns in Gaza.

This is a retrospective study comparing and characterising isolated orthopaedic combat injuries during two of Israel's military campaigns; the ongoing 'Swords of Iron' war (SOIW) and the 2014 operation 'Protective Edge' (OPE). Data were collected from the Israel Defense Forces prehospital trauma registry cross-linked with the Israel Defense Forces trauma registry during the period from 27 October 2023 to 28 July 2024 and were compared with the data from 2014 OPE.

A total of 4280 injured service members were documented in both OPE and SOIW (n=743 and n=3537, respectively). Men represent all casualties. The median age was 23 years (IQR 21-28) for SOIW and 21 years (IQR=20-24.8) for OPE. It was noted that 44.2% of the casualties during the SOIW were on reserve duty compared with only 4.3% during OPE. The leading cause of injury was explosion (56.4% for SOIW and 52.2% for OPE). Upper (43.6% vs 30.4%, p=0.11) and lower (58.9% vs 73.9%, p=0.054) extremity fractures were common in both campaigns.

While personal protective equipment provides protection to the head and torso, extremities remain exposed and thus involved in the majority of combat injuries. As orthopaedic fractures can lead to prolonged rehabilitation and potentially be life-threatening, further research is needed to enhance the planning of extremity protective measures.