Recent Orthopedic Trauma Volume in the United States Military Health System

As illustrated by the "Walker Dip," there is growing concern regarding the lack of combat casualty care during peacetime. Surgical volume and case complexity are paramount for training and skill sustainment. We sought to quantify the recent orthopedic trauma surgical case load of all military orthopedic surgeons across the Military Health System (MHS).

We queried the United States MHS Data Repository for orthopedic trauma-related Current Procedural Terminology codes for which the Accreditation Council for Graduate Medical Education (ACGME) requires graduating residents to perform a minimum case volume: hip fracture, femur/tibia shaft fracture, pilon fracture, and ankle fracture. The search yielded all corresponding procedures performed between January 2017 and December 2023 within the MHS.

There were 15,873 total ACGME-minimum orthopedic trauma procedures performed across the MHS during the study period (2,268 cases per year) for the fixation of 3,283 hip fractures, 805 femoral shaft fractures, 1,455 tibial shaft fractures, and 10,330 ankle or pilon fractures. The sole level I trauma center in the MHS, which accepts civilian trauma, performed 21% of all cases. Civilian trauma made up 70% of this military treatment facility's volume. For another military treatment facility that began accepting civilian trauma in the middle of the study period, the volume increased from 49 to 123 cases per year.

Across the MHS, there was a low volume of ACGME-minimum orthopedic trauma procedures performed. These data help to frame the current orthopedic trauma surgical volume in the United States MHS in support of efforts to maximize military surgeon training and readiness, ultimately in preparation for future conflicts.