Elsevier

Injury

Volume 36, Issue 2, February 2005, Pages 271-274
Injury

Injuries from biologic material of suicide bombers

https://doi.org/10.1016/j.injury.2004.06.016Get rights and content

Summary

Background:

The management of penetrating wounds caused by suicide bomber bone fragments, contaminated by infectious viruses such as hepatitis or human immunodeficiency virus, is a new medical challenge. The aim of this study was to review the literature and add our experience in the treatment of such wounds.

Patients and methods:

The files of 94 patients with multiple penetrating fragment injuries of the musculoskeletal system were reviewed. Following any necessary life-saving procedures, the patients underwent wound debridement with delayed wound closure. Broad-spectrum antibiotic treatment was started immediately on admission, and all patients were inoculated with antitetanus toxin and hepatitis B vaccine.

Results:

The most common injuries were multiple lacerations caused by penetration of small metal fragments. Those that were not removed on initial debridement and continued to cause pain were removed during follow-up. Twenty-three patients presented with 49 open fractures caused by the penetrating nails or impact against other objects. Three cases were complicated by chronic osteomyelitis. Three patients presented with injuries caused by bone fragments from the suicide bomber. Samples of bone from one suicide bomber tested positive for hepatitis B virus. None of the patients developed clinical signs of hepatitis B, human immunodeficiency virus or other severe infections during follow-up.

Conclusions:

The penetration of biologic material may transmit severe incurable infectious disease.

Introduction

Recent years have witnessed a world-wide escalation in suicide bomber attacks. The explosive forces that disperse nails and other metal objects embedded in the explosive device, may also disperse fragments from the body of the bomber to which the device is attached. This biologic material can cause physical injury to bystanders and may represent a source of severe infectious diseases.

One case report in the literature to date addresses the possibility of transmission of an infectious disease during a suicide bomber attack, wherein the authors found penetrating bone fragments containing tissue positive for hepatitis B surface antigen in a blast victim.1

In the present study we reviewed the literature on blast injuries from suicide bombers and added our experience in their management.

Section snippets

Materials and methods

From 2000 to 2003, our center treated 94 patients with blast and fragment injuries of the musculoskeletal system caused by suicide bombers in 12 separate events. The mean patient age was 41 years (range 14–81). The blasts occurred in open bus stations, and inside buses or restaurants.

The patients were evacuated from the scene by emergency services to nearby hospitals for triage.4 Following any necessary life-saving procedures, they were referred for surgery. Treatment with broad-spectrum

Results

The most common injuries were multiple abrasions and lacerations.

Most of the tissue injury was caused by shrapnel and nails (Fig. 1). In all affected patients, some of the nails penetrated via a small entrance site and reached deep into the muscle. Because their removal required a separate incision, they were left in situ. Those that continued to cause pain on follow-up were removed.

Many of the wounds required more than one debridement procedure before closure was possible, and some required

Discussion

Any blood-borne disease with a carrier stage, such as hepatitis B and C and HIV, can be passed to blast victims by penetration of biologic material from an infected suicide bomber or by metal fragments contaminated by his or her tissue or blood. So far in Israel, there has been one report of a patient infected by hepatitis B virus, carried by bone fragments from a suicide bomber.1

In addition, laboratory studies of three suicide bombers yielded positive findings for hepatitis B in bone fragments

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