The first wave arrived with similar injuries: severed limbs, open fractures and puncture wounds from shrapnel.

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Open fractures are usually the result of a "high-energy" trauma, according to the American Academy of Orthopaedic Surgeons website.

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The three most common complications for open fractures are infection, difficulty healing and a condition called acute compartment syndrome.

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Compound or open fractures are typically high-energy type injuries which generally occur when an individual is involved in a high velocity car accident or fall- or when a landing is awkward with twisting or torsional type forces.

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On reaching the shale, the mixture of water and fracking fluid bursts open the rock and the sand keeps the fractures open, allowing the gas to flow to the surface.

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