From the Frontlines to the Homefront: The Crucial Role of Military Orthopaedic Surgeons (original) (raw)
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Combat Orthopaedics: A View From the Trenches
Journal of the American Academy of Orthopaedic Surgeons, 2006
Approximately 70% of war wounds involve the musculoskeletal system, and military orthopaedic surgeons have assumed a pivotal role in the frontline treatment of these injuries in Iraq. Providing battlefield orthopaedic care poses special challenges; not only are many wounds unlike those encountered in civilian practice, but patients also must be triaged and treated in an austere and dangerous environment, undergo staged resuscitation and definitive surgery, and endure prolonged medical evacuation, often involving ground, helicopter, and fixed-wing transport across continents. Most orthopaedic wounds in Iraq are caused by exploding ordnance—frequently, improvised explosive devices, or IEDs. Because of advances in care, rapid medical evacuation, and modern body armor, many casualties have survived in Iraq who would not have done so in previous wars. Treatment of war wounds, many of which are devastating in the scope of soft-tissue and bony injury, requires a team approach using hypotensive resuscitation, damage-control orthopaedics, new or rediscovered techniques of hemostatic and intravenous hemorrhage control, vacuum-assisted wound closure, and advanced reconstruction. Current challenges include prevention of infection, a better understanding of heterotopic ossification as a sequela of blast injury, and the need for a comprehensive, joint service database that encompasses the multilevel spectrum of orthopaedic care.
Preparedness of Orthopaedic Surgeons for Modern Battlefield Surgery
Military Medicine, 2012
Over 220 U.S. Army orthopaedic surgeons have deployed during the Global War on Terrorism (GWOT). This study documents the orthopaedic procedures performed during the GWOT and identifies training that prepared surgeons for deployment. It reveals deficiencies in surgeons' preparedness and intends to improve predeployment training. All surgeons deployed during the GWOT from 2001 to 2007 were surveyed. Questions fit 4 general categories: deployment demographics, medical and surgical experiences, predeployment preparation, and self-perceived preparedness during deployment. Response rate was 70%. Surgeons averaged 138 adult operative cases and 26 pediatric cases per deployment. All surgeons performed irrigation and debridement, 94% external fixation, 93% amputations, 89% arthrotomies, 86% open reduction and internal fixation, and 76% soft-tissue coverage procedures. Residency and fellowship contributed most to surgeon preparedness for deployment. Surgeons generally reported high levels of preparedness, but nearly 1 in 6 reported low levels of medical, surgical and physical preparedness. More reported low levels of mental preparedness. Soft-tissue coverage was the most frequently reported surgical deficiency. This study documents the number and types of orthopaedic procedures performed during the GWOT and identifies the self-perceived preparedness deficiencies of surgeons in a combat environment. Improvements in predeployment training are needed to better prepare surgeons for managing battlefield causalities.
International Orthopaedics, 2015
Purpose Improved survival of combat casualties in modern conflicts is especially due to early access to damage control resuscitation and surgery in forward surgical facilities. In the French Army, these small mobile units are staffed with one general surgeon and one orthopaedic surgeon who must be able to perform any kind of trauma or non trauma emergency surgery. Methods This concept of forward surgery requires a solid foundation in general surgery which is no longer provided by the current surgical programs due to an early specialization of the residents. Obviously a specific training is needed in war trauma due to the special pathology and practice, but also in humanitarian care which is often provided in military field facilities. Results To meet that demand the French Military Health Service Academy created an Advanced Course for Deployment Surgery (ACDS), also called CACHIRMEX (Cours Avancé de CHIRurgie en Mission EXtérieure). Since 2007 this course is mandatory for young military surgeons before their first deployment. Orthopaedic trainees are particularly interested in learning war damage control orthopaedic tactics, general surgery life-saving procedures and humanitarian orthopaedic surgery principles in austere environments. Conclusion Additional pre-deployment training was recently developed to improve the preparation of mobile surgical teams, as well as a continuing medical education for any active-duty or reserve surgeon to be deployed.
Modern military surgery: Lessons from Iraq and Afghanistan
Journal of Bone and Joint Surgery - Series B, 2012
The types of explosive devices used in warfare and the pattern of war wounds have changed in recent years. There has, for instance, been a considerable increase in high amputation of the lower limb and unsalvageable leg injuries combined with pelvic trauma. The conflicts in Iraq and Afghanistan prompted the Department of Military Surgery and Trauma in the United Kingdom to establish working groups to promote the development of best practice and act as a focus for research. In this review, we present lessons learnt in the initial care of military personnel sustaining major orthopaedic trauma in the Middle East. War wounds range from simple low-energy fragmentation wounds to highly complex injuries. The latter have been more recently encountered in Afghanistan and are well-described by Crabtree. 1 In Iraq and Afghanistan, improvised explosive devices (IEDs) have become the insurgents' preferred weapon and were the most common cause of coalition deaths in 2009 and 2010. 2 There has also been a notable increase in very high, lower extremity amputations or unsalvageable leg injuries with pelvic trauma. 3-5 The conflicts in the Middle East prompted the Academic Department of Military Surgery and Trauma to establish working groups to promote the development of best practice and to act as a focus for research. In this review, we present lessons learnt in the initial care of military personnel sustaining major orthopaedic trauma in the Middle East. Speedier evacuation from the point of wounding can deliver patients to the Emergency Department at the very edge of survival, and the trauma care delivered by the Defence Medical Services on operations equals that available in the NHS in the United Kingdom. 6,7 A recent report by the Healthcare Commission described the military trauma system as 'exemplary'. 8 Between April 2006 and July 2008, 1474 patients were recorded on the United Kingdom's Joint Theatre Trauma Registry. Of these, 530 had an Injury Severity Score 9 > 16 and 296 survived, including unexpected survivors. 10 The Joint Theatre Trauma Registry is the United Kingdom database of all the prospectively collected data for service personnel injured on operational tour. It was started in December 2003.
Orthopaedic war injuries: recent developments in treatment and research
Instructional Course Lectures, 2009
Musculoskeletal injury is the most common type of injury among survivors of combat trauma, and combat-related trauma is challenging for an orthopaedic surgeon to treat. Methods of treatment are evolving, but significant gaps remain as knowledge of civilian trauma is extrapolated to combat trauma.