Deck-slap injuries.

To the Editor: We read with great interest the study by Ramasamy et al.1 determining the pattern of injury, medical management, and functional outcome of UK Service Personnel sustaining calcaneal injuries from undervehicle explosions. We do not totally agree with the authors when they write in the abstract, introduction, and discussion sections of their article that there have been no studies evaluating the “deck-slap” injury since World War II. Both undervehicle and naval explosions can lead to “deck-slap” injuries. Furthermore, some recent articles explored the casualties associated with naval blast. To illustrate, on October 12, 2000, the destroyer USS Cole (DDG-67) was anchored in a foreign port and was severely damaged by explosives in a small craft adjacent to the ship at the port side waterline. As a result of the blast, 56 sailors sustained injuries and 17 were killed. Lower extremity orthopedic injuries predominated in this shipboard blast scenario. In the Journal of Trauma, Davis et al.2 reviewed the distribution of injuries found in the fatalities and the wounded crew members. In all, 17 of 35 patients (49%) sustained varied orthopedic injuries. Of the 10 patients with significant injuries (requiring prolonged hospital stay 24 hours), six (60%) had orthopedic injuries. Of the 32 orthopedic injuries, 57% involved the lower extremity. Lambert et al.3 focused more specifically on the range of orthopedic injuries and outcomes of acute treatment regimens among survivors of the USS COLE terrorist attack. There were 39 patients admitted into this study. These 39 patients sustained 81 total injuries, of which 32 (40%) injuries were orthopedic injuries. Lower extremity injuries were more prevalent than upper extremity injuries (63%). Lower extremity injuries also tended to be more severe. Lambert et al. reported that of 32 orthopedic injuries, two (6%) involved the spine. Interestingly, Ramasamy et al. highlighted in their study a higher frequency of spinal lesions associated with calcaneal injuries from undervehicle explosions (9 of the 30 calcaneal fractures patients: 30%), contrasting with naval data. Ramasamy et al. described two dominant load transfer mechanisms to the target vehicle: the expansion of the detonation products and the energy transfer from soil ejecta, both transferring large amounts of energy to the axial skeleton, with the lower limbs being particularly affected. But basically, the load transfer mechanisms reported seem common to shipboard blast injuries. On the basis of their exceptional experience, we would like to know the authors’ hypothesis concerning the higher incidence of spinal injuries found in undervehicle explosions than in naval blast.