Injuries In Iraq Research Articles

Spine Injuries Sustained by U.S. Military Personnel in Combat are Different From Non-Combat Spine Injuries.

Spine injuries are more prevalent among Iraq and Afghanistan veterans than among veterans of previous conflicts. The purpose of this investigation was to characterize the context, mode, and clinical outcomes of spine injuries sustained by U.S. military personnel in theater. Injury and clinical data from patients who sustained a spine injury in Iraq or Afghanistan between 2003 and 2008 were extracted from the Joint Theater Trauma Registry. Fischer's exact test was used to compare demographic variables between battle and nonbattle spine injuries. Two-sided t tests and univariate analyses were performed to analyze the association between injury context, mechanism, and severity with clinical outcome. A total of 307 patients sustained spine injuries in theater during the study period, and 296 had adequate data for analysis. Most injuries occurred in battle (69.6%), and these injuries were more likely to have an Injury Severity Score considered severe (44.7% vs. 20.0%; p < 0.001) or critical (13.6% vs. 5.6%; p = 0.0458). Blast was the most common mechanism of injury (42.2%) and was more likely to be blunt (81.6%) than penetrating (18.4%; p < 0.0001). Battle-associated spine injuries were most commonly caused by blasts, were more severe, and more likely to involve multiple spinal levels.

Pediatric Combat Trauma

Military physicians have amassed tremendous experience treating children with combat-related injuries in Iraq and Afghanistan. This review will present several treatment principles adapted from adult trauma care that were applied to children in war and consider their selective application in civilian practice. Many standard practices of adult trauma care were applied to the management of war-injured children. Initial reports of tourniquet use, tranexamic acid administration, and balanced blood transfusion suggest a benefit to the pediatric population. Constraints of providing intensive care in an austere environment required a shift in management toward aggressive limb salvage over amputation, and early palliation for severe brain injury or extensive burns. Despite the obstacles that may limit the direct translation of trauma care principals to civilian settings, these wartime experiences offer robust and excellent preliminary data that might inform future investigations in the field of pediatric trauma care.

Musculoskeletal Injuries in Iraq and Afghanistan: Epidemiology and Outcomes Following a Decade of War.

The combined wars in Afghanistan and Iraq represent the longest ongoing conflicts in American military history, with a combined casualty estimate of >59,000 service members. The nature of combat over the last decade has led to precipitous increases in severe orthopaedic injuries, including traumatic amputations and injuries to the spine. Nearly 75% of all injuries sustained in combat now are caused by explosive mechanisms, and fractures comprise 40% of all musculoskeletal injuries. Injuries to the axial skeleton are more frequent among personnel exposed to combat, and spinal trauma is identified in nearly 40% of those killed. Musculoskeletal injuries are expensive and generate some of the highest rates of long-term disability. Noncombat musculoskeletal injuries are endemic within deployed military service members and occur at a greater than threefold rate compared with combat musculoskeletal injuries. Service members with musculoskeletal injuries or behavioral health conditions, such as posttraumatic stress disorder, depression, and psychosis, and those occupying a low socioeconomic status, have an increased risk of inferior outcomes.

Injury-related fatalities in selected governorates of Iraq from 2010 to 2013: Prospective surveillance.

After several years of relative stability in Iraq, the emergence of the Islamic State militant group has spurred a resurgence of violence. This study explores the impact of the conflict on the overall injury profile to estimate the proportion of injury fatalities related to conflict and better understand how violence has affected nonconflict-related injuries. Routine prospective injury surveillance operated by the Iraqi Ministry of Health. Surveillance data were collected from coroner offices in eight pilot governorates: Al-Anbar, Baghdad, Basrah, Erbil, Kerbala, Maysan, Ninevah, and Al-Sulaimaniya. We analyzed all fatalities from external injury causes recorded between January 1, 2010 and December 31, 2013. Analysis included 32,664 fatal injuries. Of all injury fatalities reported, 27.1 percent were conflict-related fatalities, approximately the same proportion as road traffic-related fatalities (24.4 percent) and other unintentional injuries (27.5 percent). The proportion of fatalities from conflict was approximately three times higher among males than females (33.0 percent and 10.3 percent, respectively) and four times higher among adults than children (29.8 percent and 7.3 percent, respectively). The total number of injury fatalities remained stable between 2010 and 2012; an increase in injury fatalities in 2013 was driven primarily by increases in fatalities from both interpersonal violence and conflict. From 2010 to 2013, nearly one in four injury fatalities in Iraq was attributable to conflict, a notably higher proportion than other conflict-affected countries in the region. The overall profile of nonconflict injuries in Iraq is also distinct from other countries of similar socioeconomic level that have not experienced violence.

Deaths due to Intentional Explosions in Selected Governorates of Iraq from 2010 to 2013: Prospective Surveillance.

The aim of this study was to describe the most recent trends and epidemiologic patterns of fatal injuries resulting from explosions in Iraq, one of the countries most affected by violence from explosive devices. Iraqi Ministry of Health (MoH) routine prospective injury surveillance collects information on all fatal injuries recorded by coroners from physical examinations, police reports, and family members in eight governorates of Iraq: Baghdad, Al-Anbar, Basrah, Erbil, Kerbala, Maysan, Ninevah, and Al-Sulaimaniya. This study analyzed explosive-related fatal injuries that occurred from January 1, 2010 through December 31, 2013. Analysis included 2,803 fatal injuries. The number of fatal injuries declined from 2010 through 2012, followed by an increase in 2013. One-thousand one-hundred and one explosion-related fatalities were documented in 2013, more than twice as many as in 2012 or in 2011. Most fatalities were among men aged 20-39 years. Of all causalities, 194 (6.9%) were among females and 302 (10.8%) were among children aged less than 18 years. The majority of fatalities were caused by improvised explosive devices (IEDs): car bombs (15.3%), suicide bombs (4.0%), and other IEDs (29.6%). The highest number of fatalities occurred in streets and roads. Of all deaths, 95.6% occurred in three governorates: Baghdad, Ninevah, and Al-Anbar. Explosives continue to result in a high number of fatal injuries in Iraq. Following a period of declining violence from explosives, in 2013, fatalities increased. Most explosion-related injuries resulted from IEDs; males aged 20-39 years were at greatest risk.

Isolated pediatric burn injury in Iraq and Afghanistan.

To characterize the epidemiology of burn injury in pediatric patients and identify factors associated with mortality based on burn severity. Retrospective cohort study. U.S. military combat support hospitals and forward surgical hospitals in Iraq and Afghanistan. Iraqi and Afghan children less than 18 years old admitted with isolated burn injury. None. Burn severity was classified as mild, moderate, and severe based on external Abbreviated Injury Scale score. Patient characteristics and outcomes were described according to burn severity. A multivariate logistic regression was performed on univariate associations with mortality. Of 4,743 pediatric patients, 549 (11.6%) had isolated burn injury. Overall mortality was 13%, median external Abbreviated Injury Scale was 3 (interquartile range, 2-4), and 67% were male. Variables included in the logistic regression were external Abbreviated Injury Scale score, abnormal heart rate for age, hypotension, mechanical ventilation, transfusion, Glasgow Coma Scale, international normalized ratio, base deficit, hematocrit, and platelet count. Factors independently associated with mortality were international normalized ratio (odds ratio, 2.6; 95% CI, 1.2-5.8; p = 0.021) and external Abbreviated Injury Scale (odds ratio, 2.5; 95% CI, 1.3-4.7; p = 0.004). Mortality increased with burn severity: mild 1.7%, moderate 7.2%, and severe 47% (p < 0.001). This is the first in-depth study of pediatric burn injuries in combat. Children with severe burns (total body surface area > 39% or > 29% if < 5 yr) had a high mortality and required significant resources in a setting that is not primarily resourced for long-term care of severe pediatric burn injury. Extraordinary measures are therefore used for the long-term care of these burned children within the war zones of Iraq and Afghanistan.

Neuroimaging, Behavioral, and Psychological Sequelae of Repetitive Combined Blast/Impact Mild Traumatic Brain Injury in Iraq and Afghanistan War Veterans

Abstract Whether persisting cognitive complaints and postconcussive symptoms (PCS) reported by Iraq and Afghanistan war veterans with blast- and/or combined blast/impact-related mild traumatic brain injuries (mTBIs) are associated with enduring structural and/or functional brain abnormalities versus comorbid depression or posttraumatic stress disorder (PTSD) remains unclear. We sought to characterize relationships among these variables in a convenience sample of Iraq and Afghanistan-deployed veterans with (n=34) and without (n=18) a history of one or more combined blast/impact-related mTBIs. Participants underwent magnetic resonance imaging of fractional anisotropy (FA) and macromolecular proton fraction (MPF) to assess brain white matter (WM) integrity; [(18)F]-fluorodeoxyglucose positron emission tomography imaging of cerebral glucose metabolism (CMRglu); structured clinical assessments of blast exposure, psychiatric diagnoses, and PTSD symptoms; neurologic evaluations; and self-report scales of PCS, combat exposure, depression, sleep quality, and alcohol use. Veterans with versus without blast/impact-mTBIs exhibited reduced FA in the corpus callosum; reduced MPF values in subgyral, longitudinal, and cortical/subcortical WM tracts and gray matter (GM)/WM border regions (with a possible threshold effect beginning at 20 blast-mTBIs); reduced CMRglu in parietal, somatosensory, and visual cortices; and higher scores on measures of PCS, PTSD, combat exposure, depression, sleep disturbance, and alcohol use. Neuroimaging metrics did not differ between participants with versus without PTSD. Iraq and Afghanistan veterans with one or more blast-related mTBIs exhibit abnormalities of brain WM structural integrity and macromolecular organization and CMRglu that are not related to comorbid PTSD. These findings are congruent with recent neuropathological evidence of chronic brain injury in this cohort of veterans.

Venous thromboembolism prophylaxis for patients receiving regional anesthesia following injury in Iraq and Afghanistan

Soldiers with combat-related traumatic injury are at high risk for venous thromboembolism (VTE) and often require regional anesthesia (RA) for pain control. We evaluated whether the recommended reduction in chemoprophylaxis in the presence of RA increases VTE rates. We collected data each hospital day for all soldiers admitted to the Walter Reed Army Medical Center following injury in Iraq or Afghanistan. We analyzed thromboprophylaxis and RA rates and assessed risk factors for VTE. We separated outcomes by whether RA was central neuraxial (cNAB) or peripheral blockade. Among 1,259 patients, 323 received RA for a median of 12 days (5-27 days). Those with RA were younger and more likely to have been injured in combat or by an improvised explosive device. They also received more packed red blood cell transfusions and had longer admissions. Patients with RA spent a greater percentage of days on enoxaparin 40 mg daily compared with those without RA (34.4% vs. 22.0%, p < 0.001) and more hospital days without any chemoprophylaxis (2.0 [1.0-6.0] vs. 1.0 [0.0-3.0], p < 0.001). Patients with cNAB were less likely to be placed on enoxaparin 30 mg twice daily. Patients with RA in place had mechanical prophylaxis ordered at the same rate as those without RA. Neither the presence of any RA nor cNAB specifically was associated with an increased risk for VTE. No bleeding or neurologic complications occurred in those receiving RA. Despite changes to chemoprophylaxis, soldiers wounded in combat who receive RA are not at increased risk for VTE. Therapeutic study, level III.

Characterization of Mandibular Fractures Incurred From Battle Injuries in Iraq and Afghanistan From 2001-2010

The mandible is the most commonly fractured bone in the craniomaxillofacial skeleton among military casualties. The purpose of this study was to characterize the nature and severity of mandibular fractures incurred by US military personnel during combat. We queried the Joint Theater Trauma Registry from October 2001 to April 2011 using all pertinent International Classification of Diseases, Ninth Revision codes to identify fractures of the mandible. Fractures were then classified based on type and location. Chart reviews were performed on the subset of patients who were treated at San Antonio Military Medical Center to further classify the anatomic pattern and treatment of these fractures. We identified 391 patients with mandibular fractures, of whom 45 were transferred to San Antonio Military Medical Center. Open fractures were seen in 75% of patients. Two or more fractures of the mandible were seen in 51% of patients. Comminuted fractures were present in 84%, and 31% had segmental losses. Eighty-six percent of fractures were operative; two-thirds of patients required a single surgical procedure, whereas the remaining one-third required multiple procedures. Forty-six percent of patients had pan-facial fractures. Mandibular fractures as a result of combat blast injuries were characterized by a high incidence of open, comminuted, multiple fractures. Associated facial fractures were common.

VA Prosthetic and Sensory Aids Service-65 years of progress

The JRRD article written by Stewart in 1965 entitled “Twenty Years of Progress” highlighted the progress of the Veteran Administration’s Prosthetic and Sensory Aids Service since World War II. Recognizing the importance of prosthetic and sensory aids to Veteran healthcare during those early days set the foundation for the department of today to become the largest and most comprehensive provider of prosthetic devices and sensory aids in the world. Since 1965, the world has experienced unprecedented advancements in technology and healthcare with the development of the personal computer and advent of the “Information Age,” the Internet and global communication, and the rapid evolution of microtechnology. The “Veteran Administration” has become the Department of Veterans Affairs (VA), the second largest department in the Federal government, employing more than 280,000 employees and operating America’s largest integrated healthcare system, with more than 1,700 hospitals, clinics, community living centers, domiciliaries, readjustment counseling centers, and other facilities. In fiscal year 2012, VA surpassed the level of prosthetic and sensory aids services provided in previous years, spending more than $2 billion to provide 14.5 million prosthetic devices, items, sensory aids, and services to more than 2.7 million Veterans. Nearly half of all Veterans currently seen in VA for healthcare receive prosthetic and sensory aids services and nearly onethird see a rehabilitation services healthcare provider. In the half century since publication of Stewart’s article, our nation has also been engaged in military conflicts in Vietnam, Persian Gulf, Africa, Bosnia, Kosovo, Iraq, and Afghanistan. Military medical and tactical advancements have resulted in a significant increase in the survivability of combat-related injuries in Iraq and Afghanistan. As we strive to meet VA’s core mission of serving and honoring America’s Veterans, we recognize that the goal of VA’s Rehabilitation and Prosthetic and Sensory Aids Services remains steadfast: to maximize Veterans’ independence and maintain an optimal level of physical and cognitive function that enables them to integrate successfully into their communities. The way in which VA helps Veterans successfully achieve this goal in 2013 is through a patient-centered interdisciplinary care team in a fully engaged partnership with Veterans and their families. Today, VA provides the full spectrum of world-class prosthetic and rehabilitation services for Veterans—whether such services are needed as a result of ordinary healthrelated changes or more complex and multiple injuries (i.e., polytrauma), including traumatic amputation, traumatic brain injury, spinal cord injuries and disorders, vision impairment and blindness, hearing loss, and musculoskeletal injuries. Using interdisciplinary healthcare teams and advanced systems of care to deliver rehabilitation and prosthetic services, VA provides all clinically appropriate and commercially available state-of-the-art prosthetic equipment and sensory aids and devices that cross the full range of patient care. Such items include artificial limbs and bracing, wheeled mobility and seating systems, sensory-neural aids (e.g., hearing aids, eyeglasses), cognitive prosthetic devices, items specific to women’s health, surgical implants, home respiratory care, recreational and sports equipment, and special benefits programs (to include clothing allowance, automobile adaptive equipment, and home improvement and structural alterations). VA meets the rehabilitation and prosthetic needs of Veterans in the 21st century by engaging in a dynamic process that (1) conducts and supports research to develop new technologies and clinical practices; (2) evaluates and integrates emerging products and technologies; (3) applies an evidence-based synthesis approach to assess outcomes-driven care and services; and (4) coordinates clinical

Investigation of Severe Craniomaxillofacial Battle Injuries Sustained by U.S. Service Members: A Case Series

This case series describes craniomaxillofacial battle injuries, currently available surgical techniques, and the compromised outcomes of four service members who sustained severe craniomaxillofacial battle injuries in Iraq or Afghanistan. Demographic information, diagnostic evaluation, surgical procedures, and outcomes were collected and detailed with a follow-up of over 2 years. Reconstructive efforts with advanced, multidisciplinary, and multiple revision procedures were indicated; the full scope of conventional surgical options and resources were utilized. Patients experienced surgical complications, including postoperative wound dehiscence, infection, flap failure, inadequate mandibular healing, and failure of fixation. These complications required multiple revisions and salvage interventions. In addition, facial burns complicated reconstructive efforts by delaying treatment, decreasing surgical options, and increasing procedural numbers. All patients, despite multiple surgeries, continue to have functional and aesthetic deficits as a result of their injuries. Currently, no conventional treatments are available to satisfactorily reconstruct the face severely ravaged by explosive devices to an acceptable level, much less to natural form and function.

Joint Facial and Invasive Neck Trauma (J‐FAINT) Study

Objective: 1) Describe the rate and type(s) of head and neck trauma in Iraq and Afghanistan theaters during 2003-2011 using military trauma database. 2) Determine directions for future research in personal protective and tactical gear to help prevent injury and death from facial and neck trauma in war and civilian uses. Method: Study of US servicemembers in Iraq and Afghanistan from 2003-2011. Data were collected December 2011. Examples of data include type and severity of head and neck trauma, associated injuries, age, sex, theater of injury, injury severity score, and abbreviated injury scale. Data were collected using the Joint Theater Trauma System (JTTS). Results: Data analysis is ongoing. The analysis demonstrates 7,177 service members who sustained head and neck trauma during the study period in Iraq and Afghanistan, combined. Of those patients sustaining head and neck trauma, 270 (3.8%) were killed in action or died of wounds. About one-third sustained head and/or neck trauma alone, but most had associated torso and/or extremity injuries, which increased the injury severity score. The majority of injuries occurred in Iraq. Most of the injured were in the US Army (75%), followed by the Marine Corps (20%), Air Force (3%), and Navy (2%). Most injuries were minor-moderate (AIS 1-3). Conclusion: Head and neck trauma is common in wartime, and the most recent conflicts confirm this. Many patients sustained injuries in Iraq, the majority were in the Army, and the majority were minor injuries. Most patients (96.2%) who sustained head and neck trauma survived their injuries, even when associated with extremity and torso injuries.

Injuries from combat explosions in Iraq: Injury type, location, and severity

IntroductionExplosions have caused a greater percentage of injuries in Iraq and Afghanistan than in any other large-scale conflict. Improvements in body armour and field medical care have improved survival and changed the injury profile of service personnel. This study's objective was to determine the nature, body region, and severity of injuries caused by an explosion episode in male service personnel. Materials and methodsA descriptive analysis was conducted of 4623 combat explosion episodes in Iraq between March 2004 and December 2007. The Barell matrix was used to describe the nature and body regions of injuries due to a combat explosion. ResultsA total of 17,637 International Classification of Diseases, Ninth Revision (ICD-9) codes were assigned to the 4623 explosion episodes, with an average of 3.8 ICD-9 codes per episode. The most frequent single injury type was a mild traumatic brain injury (TBI; 10.8%). Other frequent injuries were open wounds in the lower extremity (8.8%) and open wounds of the face (8.2%), which includes tympanic membrane rupture. The extremities were the body regions most often injured (41.3%), followed by head and neck (37.4%) and torso (8.8%). ConclusionThe results of this study support previous observations of TBI as a pre-eminent injury of the wars in Iraq and Afghanistan, with mild TBI as the most common single injury in this large cohort of explosion episodes. The extremities had the highest frequency of injuries for any one body region. The majority of the explosion episodes resulted in more than one injury, and the variety of injuries across nearly every body region and injury type suggests a complex nature of explosion injuries. Understanding the constellation of injuries commonly caused by explosions will assist in the mitigation, treatment, and rehabilitation of the effects of these injuries.

Magnitudes of Decline on Automated Neuropsychological Assessment Metrics Subtest Scores Relative to Predeployment Baseline Performance Among Service Members Evaluated for Traumatic Brain Injury in Iraq

: Identify the proportion of service members demonstrating declines in Automated Neuropsychological Assessment Metrics (ANAM) scores as part of a traumatic brain injury (TBI) evaluation conducted while deployed to Iraq. : Although TBI has been associated with poorer performance on cognitive test in the general population and military combatants, little is known about the proportion of service members demonstrating declines in ANAM scores after TBI. : Military personnel (N = 116) referred to a combat support hospital for TBI evaluation in Iraq underwent a standardized intake evaluation including computerized neurocognitive testing, psychological and physical health questionnaires, a clinical interview, and a physical examination by a physician. Predeployment and postinjury cognitive performance among service members with and without a TBI diagnosis was compared. : A significantly larger proportion of patients with TBI demonstrated greater declines in speed across all ANAM subtests compared with patients with no TBI. Differences in accuracy scores among patients with TBI relative to patients without TBI were nonsignificant. Patients with TBI also demonstrated greater than minimal declines on throughput Simple Reaction Time, Procedural Reaction Time, Code Substitution-Learning, and Spatial Memory scores, with no significant differences on Code Substitution-Delayed or Mathematical Processing (MATH). A similar pattern was seen among individuals examined within 72 hours of index injury. : Assessment of cognitive impairment following TBI in a combat zone may assist providers in making treatment recommendations for service members with mild TBI.

Surgical Management of Maxillofacial Injuries in Iraq

Background: One of the most demanding aspects of emergency medicine is the management of patients who have suffered facial trauma. Difficult circumstances such as the high number of casualties, severity of the facial wounds, coupled with the limited number of operating rooms and hospital beds, were a constant challenge to the surgeons. Aims of Study: This study discusses types of maxillofacial injuries and their surgical managements. Materials & methods: The following study focuses on maxillofacial injuries that were treated at Maxillofacial Unit, Ramadi Teaching Hospital and Department of Oral & Maxillofacial Surgery, College of Dentistry, Anbar University, Iraq. Total of (518) cases were chosen on the basis of them being only oral and maxillofacial injuries including 325 males and 193 females with age range from 8 to 75 years old. Results & conclusions: Most cases were in the age group (20-29) years, 312 (60.2%) patients were injured with missile fragments, isolated soft tissue injuries were found in 56 (10.8%) while, skeletal injuries were found in 462 (89.2%),facial nerve injuries which found in 57 (11%) patients, 119 (40%) patients had mandibular fractures were treated conservatively and 179 (60%) patients were treated by direct skeletal fixation.

Frequency of Mild Traumatic Brain Injury in Iraq and Afghanistan

: Rates of mild traumatic brain injury (mTBI) differ considerably between US and UK forces, despite similar methodology and similar exposure risks. We assessed, in the UK forces, if the differences in rates based on last deployment can be explained by differences in deployment length, given that US forces deploy for approximately twice as long as UK forces. : A total of 3763 personnel deployed to Iraq or Afghanistan who completed a questionnaire between 2007 and 2009. : Mild traumatic brain injury in the last deployment contrasted to current posttraumatic stress disorder, psychological distress (General Health Questionnaire-12), multiple physical symptoms, and alcohol misuse. : In the Army and Royal Marines, there was an association between length of deployment (per month) and mTBI (odds ratio: 1.31, 95% confidence interval: 1.13-1.51), which remained significant after adjustment for confounders (odds ratio: 1.25, 95% confidence interval: 1.08-1.45). No other outcome was associated with length of deployment. Results based on the total sample were similar to those in the Royal Marine and Army sample, except for adjusted multiple physical symptoms. : Comparisons of mTBI rates should take account of length of deployment when based on last deployment. Doing so reduces but does not eliminate the differences between UK and US forces.

Management of Maxillofacial Injuries in Iraq

These clinical studies reflect the experience of the author in managing 673 patients treated during the last 8 years. All patients were treated in the Maxillofacial Unit, Surgical Specialties Hospital, Medical City, Baghdad, and in the author's private clinic. Included patients were 530 males and 143 females; patients' age ranged between 1 year and 75 years (mean, 38 y). Distribution of injuries was as follows: fracture of the mandible, 287 (42.64%); middle third injuries, 39 (5.79%); orbital injuries, 236 (35.07%; including 12 cases with cranioorbital injuries); injuries in children, 27 (4.0%); fracture of the zygoma, 52 (7.73%); and fracture of the nose, 40 (5.94%).Maxillofacial injuries in this study were classified as follows: (1) craniomaxillofacial with head injuries and cerebrospinal fluid leak; (2) fracture of the middle third including Le Fort I, II, and III and midline split in the face; (3) fracture of the mandible as an isolated injury or as part of a facial skeleton injury; and (4) isolated complex injuries of the zygoma, the orbital skeleton, and the nasoethmoidal region.The technique used for treating middle third injuries was external fixation either by halo frame (with vertical rods and cheek wires) or by box frame (using 4 external pins connected by rods) or internal fixation by suspending the middle third with internal wires (0.5 mm stainless steel) from the zygomatic process of the frontal bone beneath the zygomatic arch down the lower arch bar. Fractures of the mandible were treated by gunning splint with intermaxillary fixation (IMF) or with open reduction and fixation by stainless steel wire with IMF or by IMF screw or by an arch bar and IMF. Other fractures such as fracture of the orbit were treated by bone graft, sialastic, or lyophilized dura with open reduction. Fractures of the zygoma were treated by open reduction and fixation with stainless steel wire and bone graft or by reduction without fixation. Fractures of the nose were treated by reduction with straightening of the septum with a splint (lead splint or polythene) or by external splint with plaster of Paris. With the techniques used, results from managing these cases were satisfactory.

Blast-related mild traumatic brain injury is associated with a decline in self-rated health amongst US military personnel

IntroductionMild traumatic brain injury (MTBI) has emerged as the preeminent injury of combat from the recent conflicts in Iraq and Afghanistan. Very little is known about short- and long-term outcomes after combat-related MTBI. As a measure of outcome after injury, self-rated health is a reliable, widely used measure that assesses perceived health. The primary aim of this study was to determine the effect of combat-related MTBI on self-reported health status after return from deployment. The secondary objective was to examine predictors of a decline in self-reported health status amongst US service members with MTBI, as compared to those service members with other minor non-TBI injuries. Patients and methodsMTBI cases and an injured comparison group were identified from the Expeditionary Medical Encounter Database records of 1129 male, US service members who experienced blast-related injuries in Iraq from March 2004 to March 2008. Self-rated health was assessed from the routinely administered pre- and post-deployment health assessment questionnaires by the following question, “Overall, how would you rate your health during the past month?” Possible responses were “poor”, “fair”, “good”, “very good”, or “excellent.” A distinction was made between minor and major negative changes in health (i.e., very good to fair) based on these self-rated health outcomes captured post-injury. ResultsFor all personnel, post-injury levels of self-rated health were statistically significantly worse than pre-injury health rating. At 6months post-injury, service members with MTBI were 5 times more likely to report a major negative change in health as compared to members with other mild injuries. This association was independent of age, rank, branch of service, Injury Severity Score, mental health diagnosis prior to injury, and having been referred to a health care professional. DiscussionBlast-related injuries, specifically MTBI, during deployment have negative consequences on service members’ perception of health. Future research is needed to improve our understanding of the overall effects of MTBI on health and quality of life.

The mRDH Bandage Provides Effective Hemostasis in Trauma and Surgical Hemorrhage

Traumatic injury is a major global health problem, accounting for approximately 1 in 10 deaths worldwide. Hemorrhagic shock accounts for 30% to 40% of injury-associated deaths (2/3 of those patients surviving to reach the hospital) and is the leading cause of preventable and early in-hospital mortality. Excessive blood loss is an infrequent but important complication of both elective and emergency surgery, increasing the risk of morbidity and mortality and prolonging the duration of hospital stay. The modified rapid deployment hemostat (mRDH) trauma bandage has been developed and tested during the past several years. The mRDH has a unique mechanism of action involving vasoconstriction, platelet activation, and red blood cell activation and is effective in the absence of clotting factors or platelets. The mRDH bandage has shown hemostatic efficacy in patients with severe visceral injuries and hepatic rupture. The following case studies illustrate the effective use of the mRDH bandage in a variety of settings, as follows: (1) application of the mRDH to control severe hemorrhage from an improvised explosive device-induced lower extremity injury in Iraq and (2) the mRDH terminates bleeding from a penetrating groin wound allowing safe neurosurgical intervention while avoiding a groin exploration.

Injury-Specific Correlates of Combat-Related Traumatic Brain Injury in Operation Iraqi Freedom

The prevalence of traumatic brain injury (TBI) has increased during the wars in Iraq and Afghanistan compared with 20th century military conflicts. The aim of this study was to elucidate injury-specific correlates of combat-related TBI that have yet to be clearly defined. Predominately Marine US service members who sustained brain injuries in Iraq between March 2004 and April 2008 identified from clinical records completed in the theater of combat operations (n = 2074). Severity of TBI was classified as mild, moderate, or severe. Injury-specific factors, such as injury mechanism and type, were abstracted from the clinical records and were compared with severity of TBI. Of all TBIs observed in the sample, 89% were mild. Higher severity of TBI was associated with an increased likelihood of sustaining the injury by gunshot and a lower likelihood of helmet use. Improvised explosive devices were associated with a preponderance of mild TBIs, and frequency of injuries in locations in addition to the head was highest among those with moderate and severe TBIs. Concomitant injuries to the spine/back were associated with blast injury mechanisms. Most incidents of TBI occurring during Operation Iraqi Freedom are mild in severity and a result of blast mechanisms. Multiple injuries were common, particularly as severity of TBI increased. Further research is needed to determine effects of combat-related TBI on rehabilitative and adverse health outcomes.