Soft tissue injury in an extremity caused by an explosive blast can be graded using the scheme of Hull and Cooper based on the extent of the damage. Most blast injuries from Northern Ireland resulted in fractures through the long bone rather than through the joint because of the axial stresses caused by the blast wave.


Anatomic divisions based on thirds of the extremity:

(1) upper extremity: lower, middle or lower

(2) lower extremity: lower, middle or lower


If the limb was partially severed, then it was felt too severe to allow limb salvage.


Soft Tissue Injury


confined to the level of the amputation


extends to one level away from the amputation


extends two levels away from the amputation


extends beyond two levels (involves the torso)




• The distribution appears to progress from peripheral extending centrally, rather than originating in the torso. This would go along with most landmine injuries or bombs held in the hand.

• The grading scheme assumes amputation is performed associated with mangling of the extremity. Apparently a blast sufficient to cause a large area of soft tissue injury was associated with some mangling. I will use soft tissue injury not severe enough to be associated with amputation to be Grade 0.

• The scheme did not try to combine grades when more than 1 limb was affected.


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