Characterization of Extremity Wounds in Operation Iraqi Freedom and Operation Enduring Freedom

US Army Institute of Surgical Research, Fort Sam Houston, TX, USA.
Journal of Orthopaedic Trauma (Impact Factor: 1.8). 05/2007; 21(4):254-7. DOI: 10.1097/BOT.0b013e31802f78fb
Source: PubMed


Extremity wounds and fractures traditionally comprise the majority of traumatic injuries in US armed conflicts. Little has been published regarding the extremity wounding patterns and fracture distribution in the current conflicts in Iraq and Afghanistan. The intent of this study was to describe the distribution of extremity fractures during this current conflict.
Descriptive epidemiologic study.
The Joint Theater Trauma Registry was queried for all US service members receiving treatment for wounds (ICD-9 codes 800-960) sustained in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) from October 2001 through January 2005. Returned-to-duty and nonbattle injuries were excluded. Wounds were classified according to region and type. Extremity wounds were analyzed in detail and compared to published results from previous conflicts.
A total of 1281 soldiers sustained 3575 extremity combat wounds. Fifty-three percent of these were penetrating soft-tissue wounds and 26% were fractures. Of the 915 fractures, 758 (82%) were open fractures. The 915 fractures were evenly distributed between the upper (461, 50%) and lower extremities (454, 50%). The most common fracture in the upper extremity was in the hand (36%) and in the lower extremity was the tibia and fibula (48%). Explosive munitions accounted for 75% of the mechanisms of injury.
The burden of wounds sustained in OIF/OEF is extremity injuries, specifically soft-tissue wounds and fractures. These results are similar to the reported casualties from previous wars.

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    • "The burden of musculoskeletal injuries and, in particular, amputations is well documented [1] [2] [3] [4] [5]. In spite of this, there is a relative lack of reporting on the course of those patients that undergo amputation at or after 90 days from their original injury [6] [7] [8]. "
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    ABSTRACT: Following severe lower extremity trauma, patients who undergo limb reconstruction and amputations both endure frequent complications and mental health sequelae. The purpose of this study is to assess the extent to which late amputation following a period of limb salvage impacts the evolution of the clinical variables that can affect the patient's perception of his or her limb: ongoing limb associated complications and mental health conditions. A case series of US service members who sustained a late major extremity amputation from September 2001 through July 2011 were analysed. Pre- and post-amputation complications, mental health conditions, and reason(s) for desiring amputation were recorded. Forty-four amputees with detailed demographic, injury and treatment data were identified. The most common reasons for desiring a late amputation were pain and being dissatisfied with the function of the salvage limb. An average of 3.2 (range 1-10) complications were reported per amputee prior to undergoing late amputation and an average of 1.8 (range 0-5) complications reported afterwards. The most common complication prior to and after late amputation was soft tissue infection (24 (17%) and 9 (22%), respectively). Twenty-nine (64%) late amputees were diagnosed with a mental health condition prior to undergoing their amputation and 27 (61%) late amputees were diagnosed with mental conditions after late amputation. Only three of the 15 patients who did not have a mental health condition documented prior to their late amputation remained free of a documented mental health condition after the amputation. Ongoing complications and mental health conditions can affect how a patient perceives and copes with his or her limb following severe trauma. Patient dissatisfaction following limb reconstruction can influence the decision to undergo a late amputation. Patients with a severe, combat related lower extremity injury that are undergoing limb salvage may not have a reduction in their overall complication rate, a resolution of specific complications or an improvement of their mental health after undergoing late amputation. Surgeons caring for limb salvage patients should counsel appropriately when managing expectations for a patient who desires a late amputation. Published by Elsevier Ltd.
    Injury 05/2015; 68(8). DOI:10.1016/j.injury.2015.05.015 · 2.14 Impact Factor
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    • "Just as in the wars of the last century, injuries sustained in the recent conflicts in Iraq and Afghanistan more commonly involve the limbs than any other anatomical region [1]. Approximately 25% of extremity wounds from these conflicts were open fractures [2], with only around 3% being open tibia fractures [3]. Open tibia fractures produced by military weapons are characterised by severe soft tissue loss and heavy contamination "
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    ABSTRACT: Extremity injuries define the surgical burden of recent conflicts. Current literature is inconclusive when assessing the merits of limb salvage over amputation. The aim of this study was to determine medium term functional outcomes in military casualties undergoing limb salvage for severe open tibia fractures, and compare them to equivalent outcomes for unilateral trans-tibial amputees. Cases of severe open diaphyseal tibia fractures sustained in combat between 2006 and 2010, as described in a previously published series, were contacted. Consenting individuals conducted a brief telephone interview and were asked to complete a SF-36 questionnaire. These results were compared to a similar cohort of 18 military patients who sustained a unilateral trans-tibial amputation between 2004 and 2010. Forty-nine patients with 57 severe open tibia fractures met the inclusion criteria. Telephone follow-up and SF-36 questionnaire data was available for 30 patients (61%). The median follow-up was 4 years (49 months, IQR 39-63). Ten of the 30 patients required revision surgery, three of which involved conversion from initial fixation to a circular frame for non- or mal-union. Twenty-two of the 30 patients (73%) recovered sufficiently to complete an age-standardised basic military fitness test. The median physical component score of SF-36 in the limb salvage group was 46 (IQR 35-54) which was similar to the trans-tibial amputation cohort (p=0.3057, Mann-Whitney). Similarly there was no difference in mental component scores between the limb salvage and amputation groups (p=0.1595, Mann-Whitney). There was no significant difference in the proportion of patients in either the amputation or limb salvage group reporting pain (p=0.1157, Fisher's exact test) or with respect to SF-36 physical pain scores (p=0.5258, Mann-Whitney). This study demonstrates that medium term outcomes for military patients are similar following trans-tibial amputation or limb salvage following combat trauma.
    Injury 12/2014; 46(2). DOI:10.1016/j.injury.2014.12.004 · 2.14 Impact Factor
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    • ". Although extremity injuries were reported as responsible for the majority of combat wounds in the war phases of Iraq and Afghanistan [19] [20], junctional trauma provided only a small subset of these. Clouse and colleagues [21] audited 6801 casualties presenting to Balad Air Base, the US level 3 surgical facility in Iraq, over a 24 month period up to August 2006. "
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    ABSTRACT: In a recent publication, 297 of 6450 (4.6%) military Coalition deaths over ten years were reported to be due to junctional bleeding. The authors suggested that some of these deaths could have been avoided with a junctional hemorrhage control device. Prospectively collected data on all injuries sustained in Afghanistan by UK military personnel from 1 August 2008 to 31July 2011 period were reviewed, using the UK Joint Theatre Trauma Registry. All fatalities with significant pelvic injuries were identified and analyzed, and the cause of death established to assess the potential role for a junctional haemorrhage control device. Significant upper thigh, groin or pelvic injuries were recorded in 124 casualties, of which 93 died. Of these the pelvic injury was the cause of death in 37, but only 1 casualty with potentially survivable injuries was identified where death was due to a vascular injury below the inguinal ligament, not controlled by a CAT. This represents <1% of all deaths in this period, a lower figure than previously published. We further identified 32 casualties where the cause of death was due to a vascular injury between the aortic bifurcation and the inguinal ligament. Eight of these survived to a medical facility but subsequently died of their wounds. These represent a subset in which vascular control proximal to the inguinal ligament could have altered the outcome. Some potentially survivable deaths due to exsanguination that may be amenable to proximal vascular control. Our study does not substantiate previous conclusions that this can be achieved through use of a groin junctional tourniquet. We believe there may be a role for more proximal vascular control of pelvic bleeding, and this merits further research.
    Injury 10/2014; 45(10). DOI:10.1016/j.injury.2014.07.004 · 2.14 Impact Factor
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