A Review of Orthopedic Injuries in Three Recent U.S. Military Conflicts

Abstract

We conducted a retrospective review of all patients with orthopedic injuries evacuated to a single medical center to evaluate the treatment and outcome of these injuries in three recent U.S. military conflicts: Operation Urgent Fury (Grenada), Operation Desert Shield/Storm (southwest Asia), and Operation Restore Hope (Somalia). Sixteen orthopedic casualties were originally treated at the medical detachment in Grenada before evacuation to the medical center. Most of these injuries were gunshot wounds to the extremities (11), with three known open fractures. Two patients (three extremities) sustained traumatic amputation (19% amputation rate). One hundred eighty-one patients with orthopedic injuries were medically evacuated from southeast Asia to the medical center for definitive treatment. Of these injuries, there were 143 fractures in 69 patients. One hundred of these fractures were open fractures, and 60% of these injuries were blast injuries. Furthermore, there were 26 amputations (14%). Twenty-two patients with orthopedic injuries were treated in Somalia and evacuated to the medical center. Thirteen of the 22 patients (59%) sustained gunshot wounds, and 2 (9%) sustained blast injuries. There were eight open fractures (36%) and three amputations in two patients (14%). Three of the 22 patients underwent successful limb salvage when ablation was the only other surgical alternative. It appears that a large percentage of medical center evacuations from military conflicts are for orthopedic injuries. Many of these injuries are the result of high-velocity weapons or blast injuries. Regardless of the size and/or purpose of the intervention, similar injury patterns and severity can be expected, because 51% of orthopedic patients had open fractures. Similarly, the rate of amputation associated with extremity trauma has not varied significantly since the Vietnam War.

Combat Musculoskeletal Wounds in a US Army Brigade Combat Team During Operation Iraqi Freedom

“…Meaningful comparisons of the major extremity amputation rate with previous reports are limited by a lack of consistently applied definitions and differences in population size. 21,[31][32][33] Of the 242 musculoskeletal combat wounds in this study, 35.5% were soft-tissue defects and 24% were fractures, with 44% of the fractures being open ( Table 5). The BCT had incidence rates/1,000 soldier combat-years of 5.0 and 6.4 for open and closed fractures, respectively, which had been previously unreported.…”

A method for determining the rate of major limb amputations in battle casualties: Experiences of a British Field Hospital in Iraq, 2003

“…The amputation rates from smaller scale military conflicts in Somalia (14%), Grenada (19%) and Iraq during Gulf War I (14%) were poorly defined. 4 In their paper, Islinger et al 4 suggest, but do not clearly state, that the rates of 14%, 19% and 14% in Somalia, Grenada and Iraq, respectively, relate to 'major' amputations i.e. proximal to the carpal and tarsal bones.…”

“…Following recent, smaller scale conflicts involving US troops, amputation rates of 19%, 14% and 14% were reported from Grenada, Iraq (Gulf War I) and Somalia, respectively. 4 The amputation rates quoted here were determined by the number of amputations per 'treated orthopaedic' injuries. Jovanic and colleagues, in their paper relating to the war in Croatia, quote an amputation rate of nearly 5%.…”

Foot and Ankle Reconstruction After Blast Injuries

“…In Viet Nam, military surgeons routinely performed vascular repairs and reconstructions on extremity wounds, making limb salvage a viable option for even severely injured extremities [10,23,24]. The lower extremity amputation rate has decreased to 14% in the most recent conflicts (Box 1) [9,10,25,26].…”

“…Extremity wounds have become the most common type of injury inflicted on American and Allied troops [2][3][4][5][6][7][8][9]. Two recent changes in armed conflict are responsible for this phenomenon.…”