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Deployment after limb salvage for high-energy lower-extremity trauma
Jeanne C Patzkowski1, Johnny G Owens, Ryan V Blanck
1San Antonio Military Medical Center, Fort Sam Houston, Texas 78234, USA. Jeanne.patzkowski@us.army.mil
The Journal of Trauma and Acute Care Surgery
|August 1, 2012
Summary
The Return-to-Run (RTR) pathway, using an energy-storing ankle foot orthosis and intensive rehabilitation, enabled 19.5% of wounded warriors with high-energy lower-extremity trauma to return to combat deployment or training.
Area of Science:
- Orthopedics
- Rehabilitation Medicine
- Military Medicine
Background:
- High-energy lower-extremity trauma (HELET) significantly impacts wounded warriors' physical function.
- Volumetric muscle loss, osteoarthritis, nerve injuries, and pain are common sequelae of HELET.
- Many service members aim to return to their military occupational specialty and deployment.
Purpose of the Study:
- To evaluate the effectiveness of the Return-to-Run (RTR) clinical pathway.
- To determine the rate of deployment or predeployment training among service members completing the RTR program.
- To assess the noninvasive intervention's success in facilitating high-performance goals.
Main Methods:
- Retrospective analysis of the RTR database (November 2009 - March 2011).
- Review of medical records for demographics, injury details, surgical data, and complications.
- Tracking of amputation requests and outcomes (limb salvage vs. amputation).
Main Results:
- 19.5% (17 of 87) service members completed RTR and returned to combat deployment or training.
- Most deployed individuals served in combat arms roles (Special Forces, infantry/ranger, combat engineers).
- Injuries included HELET from various mechanisms, avascular necrosis, and iatrogenic nerve injury; treatments involved external fixation, joint fusions, and nerve repair.
Conclusions:
- Achieving high-level physical function post-HELET is challenging.
- The RTR pathway, incorporating an intrepid dynamic exoskeletal orthosis and intensive rehabilitation, facilitates return to duty for a significant percentage of wounded warriors.
- This noninvasive approach aids in redeployment and mission readiness.
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