Isolated limb fractures – the underestimated injury in the Israeli Defence Forces (IDF)

Yuval Ran, Ilan Mitchnik, Sami Gendler, Guy Avital, Irina Radomislensky, Moran Bodas, Amit Benady, Avi Benov, Ofer Almog, Jacob Chen

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Introduction: Musculoskeletal injuries dominate warfare-related trauma and differ from civilian settings in higher hospitalization costs, morbidity, and mortality. Partly due to introduction of personal protective equipment in the Israel Defence Force (IDF) to minimize head and torso injuries while the extremities remained unprotected. This study describes military extremity injury patterns, prehospital treatment and injury sequela regarding return-to-duty and disability compensation. Methods: This retrospective study examined cases of battle and non-battle trauma casualties treated by the IDF Medical Corps from 2013 to 2020. Data from the IDF Trauma Registry (IDF-TR) was merged with The Israeli National Trauma Registry (INTR). Cases with high morbidity discharged from military service were compared with lower morbidity patients who returned to active duty service. Results: Out of 1360 injured soldiers, 280 (20.6%) were found to have isolated limb fractures (ILFs). High morbidity casualties had more open fractures (63% vs. 42%) and higher involvement of lower extremities (79% vs. 58%) (p < 0.001), higher rates of tourniquets use (28% compared to 9%, p < 0.001), external fixation (34% vs. 19%, p < 0.001) and amputations (9% vs. 1%, p = 0.003), required more rehabilitation (34% vs. 7%, p < 0.001), and had 46% medical disabilities compared to 24% with low morbidity (p < 0.001). Conclusions: ILFs are associated with significant morbidity and disability. High morbidity is associated with high energy, scar-producing, lower-extremity open fractured limbs treated by tourniquets. Future studies should evaluate whether junctional or extremity protective gear is combat feasible and whether introducing Clinical Practice Guidelines to manage suspected limb fractures can decrease morbidity rates and improve return to duty.

Original languageEnglish
Pages (from-to)490-496
Number of pages7
Issue number2
StatePublished - Feb 2023
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2022 Elsevier Ltd


  • Combat soldier
  • Isolated limb fracture
  • Israel defense forces
  • Military prehospital trauma
  • clinical practice guidelines


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