Extremity Injuries and Open Fractures (original) (raw)
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Injuries Sustained to the Upper Extremity Due to Modern Warfare and the Evolution of Care
The Journal of Hand Surgery, 2007
The formation of the American Society for Surgery of the Hand was related to world conflicts and hostilities. Therefore, it is appropriate that upper-extremity surgeons understand injuries resulting from modern-day combat. Because of ongoing warfare, many countries have experienced a large increase in the number of wounded service members and civilians, particularly wounds of the extremities. As a result of increased rate of survival in battlefield trauma in part because of the use of modern body armor, there is increasing complexity of extremity injuries that require complex reconstructions. Decreased mortality and a consequent increase in the incidence of injured extremities underline the need for the development of new treatment options. The purpose of this presentation is to describe upper-extremity injury patterns in modern warfare, the levels of care available, and the treatment at each level of care based on the experience
Armed Conflict Injuries to the Extremities: A Treatment Manual
JAMA, 2012
This book is designed to meet the continued need to re-learn the principles of treatment of complex war injuries to the extremities in order to minimize posttraumatic and post-treatment complications and optimize functional recovery. Most of the chapters are based on the unique experience gained in the treatment of military personnel who have suffered modern combat trauma and civilian victims of terror attacks at a single, large level 1 trauma center. The remaining chapters present the experience of leading international authorities in trauma and reconstructive surgery. A staged treatment protocol is presented, ranging from primary damage control through to definitive functional limb reconstruction. The organization of medical aid, anesthesiology, diagnostic imaging, infection prophylaxis, and management of complications are reviewed, and a special chapter is devoted to the challenging dilemma of limb salvage versus amputation in the treatment of limbs at risk.
Journal of the American Academy of Orthopaedic Surgeons
The American Academy of Orthopaedic Surgeons is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The American Academy of Orthopaedic Surgeons designates this live activity for a maximum of 15.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Occupational and Non-Occupational Injuries in the United States Army
American Journal of Preventive Medicine, 2007
Background: The differences in occupational and non-occupational injuries between military men and women have not been documented. This study compares occupational and non-occupational injuries between male and female United States Army soldiers by examining injury hospitalization rates and characteristics.
Initial management of upper extremity war injuries
Current Orthopaedic Practice, 2013
Upper extremity war injuries are complex wounds that include a combination of bone, soft-tissue, and vascular injury, and nerve loss. Treatment begins in theater with initial wound care and provisional skeletal stabilization. Once in the continental United States at a tertiary-care facility, the wounds are further debrided, and definitive treatment is initiated. Definitive treatment involves a multidisciplinary approach to treat all associated injuries. After serial debridement and irrigation to remove all devitalized tissue and contamination, a coordinated plan is made for skeletal stabilization and definitive closure or soft-tissue coverage. Options for skeletal fixation include open reduction internal fixation, external fixation, intramedullary nailing, and cement spacer placement with delayed bone grafting for segmental bone loss. Soft-tissue coverage options include delayed primary closure, dermal substitutes, skin grafting, rotational flaps, pedicled flaps, and free flaps. Treatment decisions are dictated by injury location, size of wounds, and donor site availability. Associated nerve injuries often present with large segmental defects and cannot be repaired acutely. Treatment requires delayed autograft reconstruction, with or without nerve conduits.
Musculoskeletal Lower Limb Injury Risk in Army Populations
Sports medicine - open, 2016
Injuries are common within military populations, with high incidence rates well established in the literature. Injuries cause a substantial number of working days lost, a significant cost through compensation claims and an increased risk of attrition. In an effort to address this, a considerable amount of research has gone into identifying the most prevalent types of injury and their associated risk factors. Collective evidence suggests that training and equipment contribute to a large proportion of the injuries sustained. In particular, the large loads borne by soldiers, the high intensity training programs and the influence of footwear have been identified as significant causative factors of lower limb injury in military populations. A number of preventative strategies have been developed within military bodies around the world to address these issues. The relative success of these strategies is highly variable; however, with advancements in technology, new approaches will become ...
Combat Musculoskeletal Wounds in a US Army Brigade Combat Team During Operation Iraqi Freedom
The Journal of Trauma: Injury, Infection, and Critical Care, 2011
Background: A prospective, longitudinal analysis of musculoskeletal combat injuries sustained by a large combat-deployed maneuver unit has not previously been performed. Methods: A detailed description of the musculoskeletal combat casualty care statistics, distribution of wounds, and mechanisms of injury incurred by a US Army Brigade Combat Team during "The Surge" phase of Operation Iraqi Freedom was performed using a centralized casualty database and an electronic medical record system. Results: Among the 4,122 soldiers deployed, there were 242 musculoskeletal combat wounds in 176 combat casualties. The musculoskeletal combat casualty rate for the Brigade Combat Team was 34.2 per 1,000 soldier combat-years. Spine, pelvis, and long bone fractures comprised 55.9% (33 of 59) of the total fractures sustained in combat. Explosions accounted for 80.7% (142 of 176) of all musculoskeletal combat casualties. Musculoskeletal combat casualty wound incidence rates per 1,000 combat-years were as follows: major amputation, 2.1; minor amputation, 0.6; open fracture, 5.0; closed fracture, 6.4; and soft-tissue/neurovascular injury, 32.8. Among musculoskeletal combat casualties, the likelihood of a gunshot wound causing an open fracture was significantly greater (45.8% [11 of 24]) when compared with explosions (10.6% [15 of 142]) (p ϭ 0.0006). Long bone amputations were more often caused by explosive mechanisms than gunshot wounds. Conclusions: A large burden of complex orthopedic injuries has resulted from the combat experience in Operation Iraqi Freedom. This is because of increased enemy reliance on explosive devices, the use of individual and vehicular body armor, and improved survivability of combat-injured soldiers.