Pattern of blast injuries. A systematic review: Part 2 - Landmines, unexploded ordnance and terrorism.

Clinical Snapshot

Key Findings

• P Value: Not reported — descriptive/observational synthesis without inferential statistics

• Effect Size: Landmines: lower extremity injuries most frequent, with high amputation rates. Terror attacks: extremity injuries 28–30% of all injuries; traumatic amputations 18–20%. Eye injuries disproportionately represented in landmine victims. Terror/suicide bombings produce multidimensional injury patterns varying by distance and location from blast.

• Primary Outcome: Anatomical distribution and pattern of blast injuries stratified by explosion mechanism (landmines/UXOs vs. terrorist/suicide bombings)

• Nnt Or Sensitivity: Not applicable to this descriptive systematic review. Key descriptive metrics: landmine cohort mean age 24.0 years (range across studies 8.2–32.2 years), 88.9% male (n=13,270); terror attack cohort mean age 33.1 years, 61.6% male (n=12,518)

• Confidence Interval: Not reported — narrative synthesis only, no pooled estimates with confidence intervals provided

Clinical Application

The injury pattern data are directly applicable to trauma system planning, surgical training prioritisation (lower limb reconstruction, vascular surgery, ophthalmology), mass casualty triage protocol development, and prosthetics/rehabilitation service planning. Implementation requires no new technology — findings inform existing clinical pathways. The multidimensional injury pattern of terror attacks necessitates multi-specialty trauma team activation. Australia has limited direct exposure to landmine casualties in the domestic setting, though Australian Defence Force personnel deployed to mine-affected regions (e.g., Afghanistan, Cambodia demining operations) and humanitarian workers remain at risk. The Australian Defence Force maintains dedicated trauma surgery capabilities aligned with NATO TCCC (Tactical Combat Casualty Care) guidelines. For domestic terrorism preparedness, Australian state trauma centres (e.g., Royal Melbourne Hospital, Royal Adelaide Hospital, Princess Alexandra Hospital) operate under state-based mass casualty plans. The Australasian Trauma Society and RACGP emergency preparedness guidelines support multi-specialty surge capacity for blast injury management. TGA-listed haemostatic dressings (e.g., QuikClot, HemCon) and tourniquet devices (CAT, SOFTT-W) are relevant to pre-hospital blast injury management. Rehabilitation services for traumatic amputees are supported through DVA (Department of Veterans' Affairs) for military personnel. The findings reinforce the need for ophthalmology and lower limb surgical expertise in any trauma system receiving blast casualties. Trauma surgeons, emergency physicians, military medical officers, and disaster medicine specialists managing casualties from landmine explosions, UXOs, or mass-casualty terrorist incidents. Applicable to both civilian trauma centres receiving terror attack casualties and military/humanitarian surgical teams operating in post-conflict mine-affected regions.

Abstract

PURPOSE: This systematic review analyzes the patterns and distribution of blast injuries from landmine explosions, UXOs and terror attacks including suicide bombing, in civilians and military personnel. METHODS: A search was conducted in two databases on 26. March 2025 for observational studies reporting blast injuries in civilian and military populations of all ages. Studies were clustered by explosion typ. A narrative data synthesis was performed. The JBI tool for case series was used. PROSPERO: CRD42023391736. RESULTS: 126 studies were included in the overall systematic review. 45 studies on terror & suicide bombings and 12 studies on landmines & UXOs are analyzed in the present paper. Studies on landmines from 1980 to 2006 included 13,270 individuals (age: 24.0 years (Range 8.2 years - 32.2 years); mainly male (88.9%)) in post-conflict low- and middle-income countries. Lower extremity injuries including amputations were most frequent, followed by eye injuries. Studies on terrorist attacks with a total of 12,518 mainly civilian victims (average age: 33,1 years; 61.6% males) reported on incidents in post-conflict regions and high-income cities mainly from the early 2000s. The injury pattern was multidimensional, with extremity injuries most frequent (28%-30%), including fractures, lacerations, and traumatic amputations (18%-20%). CONCLUSION: This Systematic Review Part 2 on landmines and terror attacks found that extremity injuries, including traumatic amputations, are the most frequent and dominate injury. However, the injury pattern varies depending on the explosion mechanism. Landmines primarily cause lower extremity injuries, as well as eye injuries. Terror and suicide explosions exhibit multidimensional injury pattern depending on the distance and location of the explosion.

References

1. 1.Neubert, A., Gaeth, C., Seidelmann, M., & Bieler, D. (2026). Pattern of blast injuries. A systematic review: Part 2 - Landmines, unexploded ordnance and terrorism. European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society. https://doi.org/10.2471/BLT.13.118885