Musculoskeletal Injuries in Iraq and Afghanistan

Belmont, Philip J.; Owens, Brett D.; Schoenfeld, Andrew J.

doi:10.5435/jaaos-d-15-00123

Cited by 48 publications

(28 citation statements)

References 25 publications

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“…Unlike Iraq and Afghanistan, where approximately 75% of all combat injuries were from explosive devices, we did not identify any blast injuries in the AFRICOM registry during the study period [20] . All combat injuries were secondary to GSW’s, which, given the use of effective body armor, may explain the overall low injury severity score and 100% survival rate.…”

Section: Discussionmentioning

confidence: 96%

A descriptive analysis of casualties evacuated from the Africa area of operations

Schauer

April

Naylor

et al. 2019

African Journal of Emergency Medicine

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Introduction The United States (US) military has expanded its area of operations into Africa. This medically immature theater is spread across a large region where prolonged field care (PFC) events are likely to occur. We describe trauma cases reported in the Africa Command (AFRICOM) area of operations to date within the Department of Defense Trauma Registry (DODTR). Methods We queried the DODTR for all subjects evacuated from the AFRICOM area of operations from January 2002 to June 2017. Results There were 49 subjects in the registry during our time frame from AFRICOM. Most of the evacuations came from Djibouti (53%). The median age was 29 years, most evacuees being male (92%). Non-battle injuries accounted for most of the injuries (82%), and most were US military (90%). All battle injuries were gunshot wounds (GSW). Composite injury scores were low (median 4, IQR 4–9.5). All subjects survived to hospital discharge. GSWs (22%) and sports injuries (24%) accounted for most evacuations. Serious injuries most frequently involved the extremities (18%) and the thorax (12%). The most frequent major injuries were open fractures (22%) and abdominal injuries (10%). The most frequent facility-based interventions performed were wound debridement (29%) and fracture/joint dislocation reduction (22%). Discussion Based on this dataset, most of the injuries from AFRICOM were non-battle injuries. All battle injuries were GSWs. Our study highlights the differences in casualty care needs in this region which contrast the primary explosive-based injuries seen within United States Central Command (CENTCOM) operations. The limitations of this dataset highlight the potential value of a Joint Trauma Service (JTS) data collection mandate and resource support for units within this region to facilitate targeted improvements in medical care.

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Section: Discussionmentioning

confidence: 96%

A descriptive analysis of casualties evacuated from the Africa area of operations

Schauer

April

Naylor

et al. 2019

African Journal of Emergency Medicine

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“…6) The incidence of associated spinal cord injuries is approximately 18%, which is higher than the 10% rate in nonbattle injuries [12, 13]. In the meantime, neurological functions recover poorly following combat-related injuries, requiring long-term, costly rehabilitation treatment [14, 15]. In summary, the incidence of spinal injuries is high, and the incidence of penetrating spinal fractures, noncontiguous spinal fractures, associated injuries and associated spinal cord injuries is increased in modern wars, resulting in different requirements for first aid on the scene, surgical treatment in the field and subsequent rehabilitation.…”

Section: Overviewmentioning

confidence: 99%

Chinese expert consensus on the treatment of modern combat-related spinal injuries

et al. 2019

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The battlefield treatments of spinal and spinal cord injury vary from civilian settings. However, there is no unified battlefield treatment guidelines for spine trauma in PLA. An expert consensus is reached, based on spine trauma epidemiology and the concepts of battlefield treatment combined with the existing levels of military medical care in modern warfare. Since the specialized treatment for spine trauma are no significant difference between civilian settings and modern war, the first aid, emergency treatment and early treatment of spine trauma are introduced separately in three levels in this consensus. In Level I facilities, the fast and accurate evaluation of spine trauma followed by fixation and stabilization are recommended during the first-aid stage. Re-evaluation, further treatment for possible hemorrhagic shock, dyspnea and infection are recommended at Level II facilities. At Level III facilities, it is recommended to strengthen the intensive care and the prevention of urinary system and lung infection for the wounded with severe spinal injury, however, spinal surgery is not recommended in a battlefield hospital. The grading standard for evidence evaluation and recommendation was used to reach this expert consensus.

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“…Amputations, though frequently disabling, represent only a small subset of all musculoskeletal problems, even in a war zone [ 9 ]. The overall contribution of amputations to the burden of disability is unknown, though it is clearly less than that of more prevalent musculoskeletal problems, such as fractures and acute and repetitive strain injuries [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Contribution of mental and physical disorders to disability in military personnel

Beliveau

Boulos

Zamorski

2018

Occupational Medicine

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BackgroundCombat operations in Southwest Asia have exposed millions of military personnel to risk of mental disorders and physical injuries, including traumatic brain injury (TBI). The contribution of specific disorders to disability is, however, uncertain.AimsTo estimate the contributions of mental and physical health conditions to disability in military personnel.MethodsThe sample consisted of military personnel who participated in the cross-sectional 2013 Canadian Forces Mental Health Survey. Disability was measured using the World Health Organization Disability Assessment. The International Classification of Functioning, Disability, and Health was used to classify participants with moderate/severe disability. Chronic mental disorders and physical conditions were measured by self-reported health professional diagnoses, and their contribution to disability was assessed using logistic regression and resulting population attributable fractions.ResultsData were collected from 6696 military members. The prevalence of moderate/severe disability was 10%. Mental disorders accounted for 27% (95% confidence interval [CI] 23–31%) and physical conditions 62% (95% CI 56–67%) of the burden of disability. Chronic musculoskeletal problems 33% (95% CI 26–39%), back problems 29% (95% CI 23–35%), mood disorders 16% (95% CI 11–19%) and post-traumatic stress disorder (PTSD) 9% (95% CI 5–12%) were the leading contributors to disability. After-effects of TBI accounted for only 3% (95% CI 1–4%) of disability. Mental and physical health interacted broadly, such that those with mental disorders experienced disproportionate disability in the presence of physical conditions.ConclusionsChronic musculoskeletal conditions, back problems, mood disorders and PTSD are primary areas of focus in prevention and control of disability in military personnel.

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Musculoskeletal Injuries in Iraq and Afghanistan

Cited by 48 publications

References 25 publications

A descriptive analysis of casualties evacuated from the Africa area of operations

A descriptive analysis of casualties evacuated from the Africa area of operations

Chinese expert consensus on the treatment of modern combat-related spinal injuries

Contribution of mental and physical disorders to disability in military personnel

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