On April 15, 2013, at approximately 2:49 p.m. two pressure-cooker bombs exploded one after the other at the Boston Marathon finish line. As a result of the bombings, there were three fatalities and 264 casualties, with the most severe injuries involving lower extremities of those located closest to the blasts. Shrapnel disbursed by the bombs included pieces of metal, nails and ball bearings. Injuries resulting from the Marathon bombing are relevant to the fields of rheumatology, rehabilitation, orthopedics and musculoskeletal imaging.
“In an era of terrorism, even clinicians serving non-military patients need to understand the spectrum of injuries caused by bomb explosions,” explains lead author Dr. Ali Guermazi, Professor of Radiology at Boston University School of Medicine and one of the many specialists treating bombing victims at Boston Medical Center. “Critically ill bomb-blast patients needed quick assessments of their injuries, which had the most devastating effects to the lower limbs.”
According to the Centers for Disease Control and Prevention (CDC), bombing survivors have the highest incidence of injury to soft tissue and musculoskeletal systems with the most extreme injury being traumatic amputation, which is reported in up to 3% of cases. The CDC defines primary blast injuries as those caused by the blast wave—extremely compressed air moving away from the explosion—that can damage the lungs, bowel and ears. As the wave moves from the site of the explosion it creates a vacuum, which pulls materials and debris back toward the source of the bomb blast—the refilling of this void is known as the blast wind.
Victims from the Boston Marathon bombing were subject to blast waves and blast wind resulting in soft tissue damage1, limb fractures1, and amputations. The study demonstrates the systematic need to exam each extremity for musculoskeletal, neurological and vascular damage. In accordance with previous evidence, radiography (X-ray) and computed tomography (CT-scan) should be used liberally to detect foreign objects, to define basic penetration patterns, and assess bony and soft tissue injuries.
Dr. Guermazi concludes, “While blast injuries within civilian populations are rare in the U.S., when they do occur it challenges the medical community to rapidly respond to concurrent evaluation and treatment of many victims. We suggest that in urgent situations, like the Boston Marathon bombing, radiology resources be used liberally to save the lives and limbs of patients.”
1 Photos available upon request.
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Full citation: “Imaging of Blast Injuries to the Lower Extremities Sustained in The Boston Marathon Bombing.” Ali Guermazi, Daichi Hayashi, Stacy E. Smith, William Palmer and Jeffrey N. Katz. Arthritis Care and Research; Published Online: August 19, 2013 (DOI: 10.1002/acr.22113).
URL Upon Publication: http://doi.wiley.com/10.1002/acr.22113
Author Contact: To arrange an interview with Dr. Guermazi, please contact Maria Pantages Ober with Boston University School of Medicine and Boston Medical Center at [email protected]
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Arthritis Care & Research is an official journal of the American College of Rheumatology (ACR), and the Association of Rheumatology Health Professionals (ARHP), a division of the College. Arthritis Care & Research is a peer-reviewed journal that publishes both original research and review articles that promote excellence in the clinical practice of rheumatology. Relevant to the care of individuals with arthritis and related disorders, major topics are evidence-based practice studies, clinical problems, practice guidelines, health care economics, health care policy, educational, social, and public health issues, and future trends in rheumatology practice. The journal is published by Wiley on behalf of the ACR. For more information, please visit the journal home page at http://wileyonlinelibrary.com/journal/acr.
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