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Combat orthopaedics: a view from the trenches.

¹Department of Orthopaedic Surgery, Naval Medical Center, San Diego, CA, USA.

The Journal of the American Academy of Orthopaedic Surgeons

|September 28, 2006

Summary

Military orthopaedic surgeons face unique challenges treating musculoskeletal war wounds in Iraq, primarily from improvised explosive devices (IEDs). Advances in care enable more casualties to survive, requiring a multidisciplinary approach for complex injuries.

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Area of Science:

Orthopaedic Surgery
Military Medicine
Trauma Care

Background:

Approximately 70% of war wounds affect the musculoskeletal system.
Battlefield orthopaedic care presents unique challenges due to wound types and austere environments.
Improvised explosive devices (IEDs) are a frequent cause of orthopaedic injuries in conflict zones like Iraq.

Purpose of the Study:

To highlight the pivotal role of military orthopaedic surgeons in treating war-related musculoskeletal injuries.
To discuss the challenges and necessary adaptations in providing frontline orthopaedic care in combat zones.
To outline the multidisciplinary treatment strategies for complex war wounds.

Main Methods:

Review of frontline orthopaedic care practices in Iraq.

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Application of hypotensive resuscitation and damage-control orthopaedics.

Utilization of vacuum-assisted wound closure and advanced reconstruction techniques.

Main Results:

Advances in care, rapid evacuation, and body armor have increased casualty survival rates.
Treatment requires a team approach integrating resuscitation, hemorrhage control, wound management, and reconstruction.
Devastating soft-tissue and bony injuries necessitate comprehensive management strategies.

Conclusions:

Effective treatment of war-related orthopaedic injuries demands a coordinated team effort and specialized techniques.
Ongoing challenges include infection prevention, understanding heterotopic ossification, and establishing a joint service database.
Continued research and data collection are crucial for advancing the care of combat casualties.