Purpose: The aims of the present study were: (a) to identify the incidence of osteoarthritis (OA) after a traumatic knee injury; (b) identify the risk of post-traumatic osteoarthritis (PTOA) based on the type of injury; and (c) identify the time from injury to OA diagnosis.Patients and methods: The Expeditionary Medical Encounter Database, containing healthcare utilization for all deployment injuries sustained by military service members, was queried for traumatic knee injuries between 2001 and 2016. Subsequent diagnosis of knee OA was identified, defined as PTOA. Time to knee PTOA diagnosis was determined and logistic regression was used to obtain odds ratios (ORs) (95% confidence interval [CI]) between knee injury type and development of PTOA.Results: A total of 345 (9.57%) of the 3,605 subjects were diagnosed with PTOA.The median time to diagnosis was 4.10 years. Four primary diagnoses remained significantly associated with PTOA after adjusting for age and injury severity score: fracture (adjusted OR [aOR] = 1.36; 95% CI 1.02, 1.82), sprain (aOR = 1.59; 95% CI 1.23, 2.06), dislocation (aOR = 3.70; 95% CI 2.09, 6.55) and derangement (aOR = 2.38; 95% CI 1.33, 4.28). Subjects were significantly less likely to develop PTOA after a softtissue injury (aOR = 0.44; 95% CI 0.41, 0.75). Conclusions:A substantial number of individuals with a traumatic knee injury developed early PTOA (9.6%). Certain knee injuries have a greater association with PTOA. Future studies should implement longer surveillance periods and identify other healthcare variables associated with the risk of developing PTOA, to include appropriate and timely interventions.

Background: Limited population-based research has described long-term health outcomes following combat-related upper limb amputation. Objective: To compare health outcomes following upper limb amputation with outcomes following serious upper limb injury during the first 5 years postinjury. Design: Retrospective cohort. Setting: Departments of Defense (DoD) and Veterans Affairs (VA) inpatient and outpatient health care facilities. Participants: Three-hundred eighteen U.S. Service Members. Methods: Patients sustained an above elbow (AE, n = 51) or below elbow (BE, n = 80) amputation or serious arm injury without amputation (NO AMP, n = 187) in the Iraq or Afghanistan conflicts, 2001 through 2008. Injuries were coded by trauma nurses. Outcomes came from DoD and VA health databases. Main Outcome Measurements: International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes. Results: Most patients were injured by blast weaponry causing serious to severe injuries. All groups had a high prevalence of physical and psychological health diagnoses. The prevalence for nearly all wound complications and many physical and psychological disorders decreased substantially after postinjury year 1. The prevalence of posttraumatic stress disorder, however, increased significantly from postinjury year 1 (20%) to 3 (36%). Pain and psychological disorders ranged from 69% to 90% of patients during postinjury year 1 and remained relatively high even postinjury during year 5 (37%-53%). After adjusting for covariates, the AE group had significantly higher odds for some physical and psychological diagnoses (eg, deep vein thrombosis/pulmonary embolism, cervical pain, osteoarthritis, obesity, and mood and adjustment disorders) relative to the BE or NO AMP groups. BE patients had significantly lower odds for osteomyelitis, and AE and BE patients had lower odds for fracture nonunion and joint disorders versus NO AMP. Conclusions: The results identify similarities and differences in clinical outcomes following combat-related upper limb amputation versus serious arm injury and can inform medical planning to improve rehabilitation programs and outcomes for these patients.Patients with combat-related above-elbow amputation had five times higher odds than patients with serious arm injury without amputation for developing: a. Anemia b. Deep vein thrombosis/Pulmonary Embolism c. Infection d. Arthritis

Introduction Ketamine is an alternative to opioids for prehospital analgesia following serious combat injury. Limited research has examined prehospital ketamine use, associated injuries including traumatic brain injury (TBI) and PTSD outcomes following serious combat injury. Materials and Methods We randomly selected 398 U.S. service members from the Expeditionary Medical Encounter Database who sustained serious combat injuries in Iraq and Afghanistan, 2010-2013. Of these 398 patients, 213 individuals had charted prehospital medications. Clinicians reviewed casualty records to identify injuries and all medications administered. Outcomes were PTSD diagnoses during the first year and during the first 2 years postinjury extracted from military health databases. We compared PTSD outcomes for patients treated with either (a) prehospital ketamine (with or without opioids) or (b) prehospital opioids (without ketamine). Results Fewer patients received prehospital ketamine (26%, 56 of 213) than only prehospital opioids (69%, 146 of 213) (5%, 11 of 213 received neither ketamine nor opioids). The ketamine group averaged significantly more moderate-to-serious injuries, particularly lower limb amputations and open wounds, compared with the opioid group (Ps < .05). Multivariable regressions showed a significant interaction between prehospital ketamine (versus opioids) and TBI on first-year PTSD (P = .027). In subsequent comparisons, the prehospital ketamine group had significantly lower odds of first-year PTSD (OR = 0.08, 95% CI [0.01, 0.71], P = .023) versus prehospital opioids only among patients who did not sustain TBI. We also report results from separate analyses of PTSD outcomes among patients treated with different prehospital opioids only (without ketamine), either morphine or fentanyl. Conclusions The present results showed that patients treated with prehospital ketamine had significantly lower odds of PTSD during the first year postinjury only among patients who did not sustain TBI. These findings can inform combat casualty care guidelines for use of prehospital ketamine and opioid analgesics following serious combat injury.