Operation Iraqi Freedom: the Landstuhl Regional Medical Center experience

Landstuhl Regional Medical Center, Germany, the only American medical center in Europe, received approximately 80% of American military patients evacuated out of theater during the first 4 months of Operation Iraqi Freedom. 1236 patients arrived at Landstuhl Regional Medical Center from the beginning of Operation Iraqi Freedom until May 15, 2003, consisting of 256 battle casualties (20.7%), 510 injury patients (41.3%), and 470 disease patients (38.0%). Retrospective record reviews were done on all battle casualties, as well as all disease and injury patients with a musculoskeletal diagnosis. Of the battle casualty patients, 68.4% suffered an extremity injury--a percentage that is consistent with that from prior wars. 52.8% had a lower extremity injury and 21.5% had a foot or ankle injury. Additionally, of all disease and non-battle injury patients with a musculoskeletal diagnosis, 74.7% had an extremity complaint, 44.1% had a lower extremity diagnosis, and 23.2% had foot or ankle pathology. Of all 1236 patients evacuated during this period, 39.5% had extremity pathology, 25.8% had lower extremity pathology, and 12.4% had foot and ankle pathology in isolation or combined with other complaints. Extremity injuries, and specifically lower extremity injuries, continue to be the predominant wounding pattern found in surviving troops in modern warfare. Proper staffing and positioning of medical specialties involved in musculoskeletal trauma care is vital in ensuring proper casualty care in future conflicts.