Advancements in Military Orthopaedics Aid in Care of Injured Service Personnel

CHICAGO, March 23 /PRNewswire/ -- Thanks to improvements in body armor and armored vehicles, intense training of U.S. military personnel and advances in medical care, the survivability of those wounded in the Iraq War has increased from past wars. While military medicine, technology and equipment have progressed over the years, more knowledge needs to be extracted to properly care for our injured combatants. Current military treatments -- including a study reviewing patterns of musculoskeletal injuries during the Iraq War -- and highlights from the recent Extremity War Injuries (EWI) symposium were discussed today at the 73rd Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

According to the U.S. Department of Defense's Directorate for Information Operations and Reports, during World War II, the likelihood of surviving battlefield wounds was 69.7 percent; by the end of the Vietnam War it had improved to 76.4 percent; and survival of those wounded in the current Iraq War has increased to an astounding 90.4 percent. With approximately 70 percent of war wounds involving the musculoskeletal system, military orthopaedic surgeons are playing an increasingly pivotal role in treating combat casualties in both Iraq and Afghanistan.

"We are seeing more unique, severe injuries in this war because a growing number of service men and women are surviving and needing treatment," stated Andrew N. Pollak, MD, associate professor of orthopaedic surgery at the University of Maryland School of Medicine and attending orthopaedic trauma surgeon at the R Adams Cowley Shock Trauma Center, both in Baltimore, and chair-elect of the AAOS' Board of Specialty Societies. "It's important to continually examine the types of wounds and infections military orthopaedic surgeons are treating so we can direct research towards helping them provide our troops with the most timely, effective care possible."

At the recent EWI symposium, experts explored all aspects of medical care in the current war to understand where more research is needed to define ways to fight infection, manage wounds, treat severe factures and improve amputee care. The symposium's goal was to prioritize future military orthopaedic trauma research topics and determine the next steps to understand more about extremity war injuries. Key findings included: a team approach is important to care of injured military personnel; a total rehabilitation program is crucial to amputee care; new antibiotics may be valuable in fighting severe infections in Iraq's unique environment; and the need for additional research to learn how to treat major bone loss in blast injuries, and techniques of debridement -- removal of loose particles or debris from injured limbs --- in austere environments is vital.

"We need to understand what techniques are most effective in treating these severe injuries, as well as what approaches work best in combat environments," explained Dr. Pollak. "These advancements will not only help our military personnel now, but can help civilians -- who experience high- energy trauma -- in the future."

CAPT D.C. Covey, MD, chair of the department of orthopaedic surgery at Naval Medical Center, San Diego, and orthopaedic consultant to the Surgeon General of the Navy -- along with a team of researchers -- conducted a study to determine patterns of musculoskeletal injuries sustained by combatants during the Iraq War. Data was collected on 377 patients with musculoskeletal war wounds treated surgically over a 12-month period at a level II U.S. Marine Corps surgical team in Fallujah, Iraq. The wounding agent, ballistics, spectrum/distribution of orthopaedic wounds and associated injury patterns were analyzed. Treatment included wound exploration; irrigation or cleaning of the injured limb; debridement; fracture stabilization; and broad-spectrum antibiotics.

"If we devote additional time and money into military research, more can be learned," stated CAPT Covey. "During time of war, we are forced to grasp things quickly, but it's extremely important to critically examine our practices so we deliver the best care possible to our injured service members."

The researchers found that 234 patients were injured by explosive munitions, and 143 by gunshot. Regardless of the magnitude of trauma, explosive injuries were determined to be qualitatively different from gunshot wounds, were often associated with much greater loss of muscle and bone and increasingly involved the arms. The most mutilating wounds were caused by explosives -- predominantly improvised explosive devices (IEDs) -- which injured 63 patients and accounted for nearly half the total number of amputations performed. The contamination and soft tissue injuries caused by IEDs required a more aggressive treatment approach than for most gunshot wounds. Injuries were successfully treated using a specific protocol of treatments: surgical debridement; leaving all wounds open; early fracture stabilization; broad-spectrum antibiotics; and rapid evacuation to higher levels of care.

"As a result of innovations during the Vietnam War, rapid helicopter transport and designated trauma centers are now commonplace," explained CAPT Covey. "Who knows what medical advances may result from the current conflict."

CAPT Covey received external funding from the Fisher Foundation for his research.

An orthopaedic surgeon is a physician with extensive training in the diagnosis and non-surgical as well as surgical treatment of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles and nerves.

With more than 29,000 members, the American Academy of Orthopaedic Surgeons ( http://www.aaos.org/ ) or ( http://www.orthoinfo.org/ ) is the premier not-for-profit organization that provides education programs for orthopaedic surgeons and allied health professionals, champions the interests of patients and advances the highest quality musculoskeletal health. Orthopaedic surgeons and the Academy are the authoritative sources of information for patients and the general public on musculoskeletal conditions, treatments and related issues. An advocate for improved patient care, the Academy is participating in the Bone and Joint Decade ( http://www.usbjd.org/ ) -- the global initiative in the years 2002-2011 -- to raise awareness of musculoskeletal health, stimulate research and improve people's quality of life. The Academy's Annual Meeting is being held March 22-26, 2006 at McCormick Place in Chicago.