UC San Diego

➤ Junctional injuries are those spanning the root of an extremity and the adjacent torso to include the shoulder region (shoulder and thoracic outlet) or pelvic region (pelvis, lower part of the abdomen, and proximal part of the thigh). ➤ These anatomic regions are traversed by major neurovascular structures where proximal and distal hemorrhage control is necessary in the torso and involved extremity. ➤ Nineteen percent of battlefield deaths from potentially survivable hemorrhage in Iraq and Afghanistan occurred in junctional anatomic regions. ➤ Patients with junctional injuries who present in extremis benefit from a resuscitation protocol that prioritizes control of life-threatening bleeding. ➤ A coordinated effort with general and orthopaedic surgeons working together can maximize chances for survival. ➤ Intermingling of new developments in the mitigation and treatment of junctional injuries will hopefully decrease their associated morbidity and mortality.