Diagnostic imaging of blast injuries to the limbs in specialized and high-tech surgical care

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Abstract

BACKGROUND: Explosive weapons that cause complex multisystem injuries are becoming increasingly prominent in today’s local hostilities and armed conflicts. Mine blast injuries, including limb injuries, are the most severe. These injuries necessitate the most advanced diagnostic tools, such as diagnostic imaging, which facilitates the assessment of bone, joint, vascular, and nerve injuries. The existing data on the significance of diagnostic imaging findings are inconsistent, with studies typically assessing a single technique. Therefore, a comprehensive imaging examination in patients with blast injuries to the limbs is relevant.

AIM: This study aimed to improve the diagnosis of blast injuries to the limbs in specialized and high-tech surgical care using diagnostic imaging. Furthermore, we aimed to assess the severity and localization of blast injuries to the limbs during the special military operation, as well as the capabilities, advantages, and limitations of diagnostic imaging techniques used in specialized and high-tech surgical care.

METHODS: The findings of various diagnostic imaging techniques were assessed, including conventional digital radiography, computed tomography, computed tomography angiography, nerve ultrasound, and Doppler ultrasound of the extremities. The study examined data from 108 combatants with blast injuries to the limbs. In the main group, which included 83 wounded patients, a specific diagnostic imaging algorithm was used prior to specialized surgical care. The control group, which included 25 wounded patients, received on-demand treatment with no specific algorithm.

RESULTS: A comprehensive diagnostic imaging algorithm in patients with blast injuries to the limbs significantly reduced the rate of diagnostic errors compared to wounded patients with on-demand diagnostic imaging (9.63% vs 28%; p = 0.01).

CONCLUSION: The findings indicate that the proposed diagnostic algorithm (radiography—Doppler ultrasound of the arteries and veins of the extremities—computed tomography—nerve ultrasound—computed tomography angiography) provided all the necessary diagnostic data. Furthermore, it significantly reduced the need for additional examinations, patients’ radiation exposure, and the rate of diagnostic errors.

About the authors

Albina G. Frumen

Main Military Clinical Hospital of the National Guard Troops of the Russian Federation

Author for correspondence.
Email: frumenag@mail.ru
ORCID iD: 0009-0004-8382-8379
SPIN-code: 5052-2936

MD, senior radiologist at the X-ray Department of the Center for Radiation Diagnostics

Russian Federation, Balashikha

Gennady E. Trufanov

V.A. Almazov National Medical Research Centre

Email: trufanovge@mail.ru
ORCID iD: 0000-0002-1611-5000
SPIN-code: 3139-3581

MD, Dr. Sci. (Medicine), Professor, the Head of the Department of Radiation Diagnostics and Medical Imaging with the clinic

Russian Federation, Saint Petersburg

Sergey V. Chevychelov

Main Military Clinical Hospital of the National Guard Troops of the Russian Federation; Russian Biotechnological University

Email: sergmed46-50@mail.ru
ORCID iD: 0009-0004-4974-5756
SPIN-code: 3935-0076

MD, the Head of the Department of Ultrasound Diagnostics—Doctor of ultrasound diagnostics of the Center for Radiation Diagnostics, senior lecturer at the Department of Radiation Methods of Diagnosis and Treatment

Russian Federation, Balashikha; Moscow

Tatyana A. Arefyeva

Main Military Clinical Hospital of the National Guard Troops of the Russian Federation

Email: tanya-arefeva2015@mail.ru
ORCID iD: 0009-0003-2541-0639

MD, Senior Physician of the Ultrasound Diagnostics Department of the Radiation Diagnostics Center

Russian Federation, Balashikha

Igor S. Obelchak

Main Military Clinical Hospital of the National Guard Troops of the Russian Federation; Russian Biotechnological University

Email: obelchak2007@mail.ru
ORCID iD: 0009-0009-7197-6645
SPIN-code: 8337-2261

MD, Dr. Sci. (Medicine), Associate Professor, the Head of the Department of Radiological Methods of Diagnosis and Treatment, radiologist of the X-ray department of CT and MRI of the Center for Radiology

Russian Federation, Balashikha; Moscow

Kirill M. Shashkin

Main Military Clinical Hospital of the National Guard Troops of the Russian Federation; Russian Biotechnological University

Email: avanzatoelcostra@gmail.com
ORCID iD: 0009-0006-6974-1730
SPIN-code: 5007-4339

the Head of the X-ray Department of the Center for Radiation Diagnostics, Senior Lecturer at the Department of Radiation Methods of Diagnosis and Treatment

Russian Federation, Balashikha; Moscow

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