Page 28 - JSOM Spring 2026

patients analyzed ranged from single cases in case reports to force trauma was commonly associated with closed abdomi-
cohorts of up to 6,313 patients in larger observational studies. nal injuries and spinal damage, often occurring due to high-
More details are provided in Table 1. velocity impacts, blast wave effects, or structural collapses. 28,32

Patient Characteristics A detailed classification and distribution of these injury pat-
The age of injured individuals ranged from 18 to 75 years, terns are presented in Table 2.
with military-focused studies reporting mean ages between 24
and 40, reflecting the typical age distribution of active-duty Management Plan
personnel. 17,18 Nearly all participants were male, with only two The management of these complex combat-related injuries
studies reporting female patients. 19,20 Most studies focused ex- necessitated a multidisciplinary, multi-stage approach, inte-
clusively on military personnel, although three included both grating both surgical and rehabilitative strategies to optimize
civilian and military casualties, reflecting an increasing trend patient outcomes. Surgical interventions played a pivotal role
in civilian injuries. 5,12,21 Only one study specifically examined in the initial phase, with many patients requiring amputations
civilian patients receiving treatment in frontline medical facil- followed by revision surgeries for stump reconstruction to
22
ities. Detailed patient demographics are provided in Table 1. ensure optimal prosthetic fitting and function. 17,21,23 Fracture
management frequently involved external fixation techniques,
Injury Characteristics such as the Ilizarov method, 17,23,29,31,38 alongside internal fix-
The injuries analyzed in this review were often severe and ation and bone grafting procedures to restore structural in-
highly complex, frequently affecting multiple body regions. tegrity. In cases involving neurological damage, neuroma
29
Soft-tissue injuries, particularly those resulting from shrap- excision and nerve repair techniques were essential for pre-
nel wounds and gunshot trauma, were among the most serving and restoring function. 17,25,34
common. 12,21,23–27 Fractures ranged from stress fractures to
28
severe bone breaks requiring advanced reconstructive tech- Additionally, soft-tissue repair was a critical component of
niques. 21,24,29,30 High-energy explosions from landmines and surgical management, with advanced flap techniques, skin
other explosive devices frequently led to traumatic amputa- grafting, and vacuum-assisted closure (VAC) therapy widely
tions. 12,19,21,31,32 Neurological damage, including nerve injuries, employed to enhance wound healing and reduce the risk of
neuromas, and spinal cord trauma, was another significant infection. 5,20,26,37 To further improve functional outcomes,
finding. 17,25,32 In the case presented by Gybalo et al., the patient cutting-edge reconstructive techniques, including 3D-printed
(a combatant) sustained gunshot wounds to the chest and arm; implants and distraction osteogenesis, were used for complex
the bullet ultimately lodged in the neck, near critical vascular skeletal reconstruction and limb salvage. 25
structures (the left common carotid artery and internal jugular
27
vein), without associated fractures or pneumothorax. Addi- Beyond surgical interventions, medical and rehabilitation
tionally, complications such as compartment syndrome and strategies were essential for restoring function and improv-
post-amputation hypersensitivity required long-term medical ing long-term quality of life. Pain management incorporated
management. 28,33 More details are provided in Table 2. multimodal analgesia, addressing both acute postoperative
pain and neuropathic pain syndromes, which are common in
Mechanism of Injury and Types of Weapons war-related injuries. Intensive physiotherapy and prosthetic
18
The predominant cause of these injuries was high-energy com- rehabilitation were fundamental in facilitating mobility resto-
bat trauma, primarily resulting from explosive mechanisms ration and maximizing patient independence. 19,23,24,38
such as anti-personnel mines, drones, artillery shells, explosive
devices, rockets, and grenades. 5,17,19,29 These explosive events Psychological and social support were equally crucial in the
generated complex polytrauma patterns, often inflicting severe rehabilitation process, aiding in the reintegration of injured in-
musculoskeletal and neurological damage. dividuals into professional and daily life activities. 19,35 Special-
ized programs targeted post-traumatic stress disorder (PTSD)
Gunshot wounds also represented a significant proportion of and the psychological impact of limb loss, ensuring a holistic
combat-related injuries, leading to extensive soft-tissue de- recovery approach. In select cases, experimental regenerative
struction, comminuted fractures, and the retention of metal- medicine techniques, including live cell therapy for nerve re-
lic foreign bodies within deep anatomical structures. 12,22,29,33,34 generation, were explored as potential adjunctive treatments
The ballistic forces involved in these injuries frequently caused for nerve injuries. 34
cavitation effects, exacerbating tissue disruption and compli-
cating surgical management. The overall clinical outcomes varied based on injury severity
and treatment complexity. While many patients successfully re-
Blast-related trauma not only resulted in severe skeletal injuries gained mobility and reintegrated into daily life, some required
but also had profound neurological implications, often leading long-term follow-up due to complications such as chronic
to multisystem involvement within a single casualty. 5,26,32,34–37 stump pain and persistent psychological distress. Ultimately,
The combination of primary blast waves, secondary projec- the extent of functional recovery was heavily influenced by the
tile penetration, tertiary blunt force impact, and quaternary effectiveness of surgical and rehabilitative strategies, with ad-
thermal or chemical effects compounded the severity of these vanced treatment modalities significantly enhancing long-term
injuries. prognoses. A detailed breakdown of injury management and
outcomes is presented in Table 2.
Furthermore, ballistic trauma frequently resulted in deep-
penetrating wounds, with metallic fragments embedded within Quality Assessment
soft tissues and bony structures, necessitating complex de- The quality of the included case reports was high; most re-
bridement and reconstructive procedures. Additionally, blunt ceived 7 out of 8 points. The case reports thoroughly described
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26 | JSOM Volume 26, Edition 1 / Spring 2026