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Environment at the time of injury determines injury patterns in pelvic blast
  1. Claire Elizabeth Webster1,
  2. J Clasper2,
  3. I Gibb3 and
  4. S D Masouros4
  1. 1 Centre for Blast Injury Studies, Imperial College London, London, UK
  2. 2 Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
  3. 3 Radiology, HMS Nelson, Portsmouth, UK
  4. 4 The Royal British Legion Centre for Blast Injury Studies, Imperial College London, London, UK
  1. Correspondence to Claire Elizabeth Webster, Centre for Blast Injury Studies, Imperial College London, London SW7 2AZ, UK; claire_elizabeth999{at}


The use of explosives by terrorists, or during armed conflict, remains a major global threat. Increasingly, these events occur in the civilian domain, and can potentially lead to injury and loss of life, on a very large scale. The environment at the time of detonation is known to result in different injury patterns in casualties exposed to blast, which is highly relevant to injury mitigation analyses. We describe differences in pelvic injury patterns in relation to different environments, from casualties that presented to the deployed UK military hospitals in Iraq and Afghanistan. A casualty on foot when injured typically sustains an unstable pelvic fracture pattern, which is commonly the cause of death. These casualties die from blood loss, meaning treatment in these should focus on early pelvic haemorrhage control. In contrast, casualties injured in vehicle present a different pattern, possibly caused by direct loading via the seat, which does not result in pelvic instability. Fatalities in this cohort are from injuries to other body regions, in particular the head and the torso and who may require urgent neurosurgery or thoracotomy as life-saving interventions. A different strategy is therefore required for mounted and dismounted casualties in order to increase survivors.

  • blast
  • pelvic fracture
  • personnel protective equipment
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  • Contributors All authors had key contributions to data collection, analysis and writing of the manuscript.

  • Funding The authors would like to thank the Royal British Legion for their ongoing financial support for research activity at the Centre for Blast Injury studies.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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