Injuries In Military Personnel Research Articles

Comparison of Concussive Symptoms, Cognitive Performance, and Psychological Symptoms Between Acute Blast-Versus Nonblast-Induced Mild Traumatic Brain Injury

Blast-related head injuries are one of the most prevalent injuries among military personnel deployed in service of Operation Iraqi Freedom. Although several studies have evaluated symptoms after blast injury in military personnel, few studies compared them to nonblast injuries or measured symptoms within the acute stage after traumatic brain injury (TBI). Knowledge of acute symptoms will help deployed clinicians make important decisions regarding recommendations for treatment and return to duty. Furthermore, differences more apparent during the acute stage might suggest important predictors of the long-term trajectory of recovery. This study evaluated concussive, psychological, and cognitive symptoms in military personnel and civilian contractors (N = 82) diagnosed with mild TBI (mTBI) at a combat support hospital in Iraq. Participants completed a clinical interview, the Automated Neuropsychological Assessment Metric (ANAM), PTSD Checklist-Military Version (PCL-M), Behavioral Health Measure (BHM), and Insomnia Severity Index (ISI) within 72 hr of injury. Results suggest that there are few differences in concussive symptoms, psychological symptoms, and neurocognitive performance between blast and nonblast mTBIs, although clinically significant impairment in cognitive reaction time for both blast and nonblast groups is observed. Reductions in ANAM accuracy were related to duration of loss of consciousness, not injury mechanism.

Maxillofacial injuries in military personnel treated at the Royal Centre for Defence Medicine June 2001 to December 2007

Since its formation in June 2001, the Royal Centre for Defence Medicine (RCDM) at Birmingham University Hospitals NHS Foundation Trust has treated most of the British military personnel who have sustained serious maxillofacial injuries while serving abroad. We retrospectively analysed all recorded maxillofacial injuries of personnel evacuated to the RCDM between June 2001 and December 2007. We know of no existing papers that describe oral and maxillofacial injuries of military personnel, or workload in the 21st century. During the period 119 personnel with maxillofacial injuries were evacuated to the RCDM for treatment 83% of whom were injured in Iraq or Afghanistan. In total 61% (72/119) of injuries were caused by improvised explosive devices, 9% (11/119) were gun shot wounds, and 1% were caused by aircraft incidents. A further 29% (35/119) of patients had injuries not associated with battle. The most common injuries were facial lacerations (106/119). There were 54 facial fractures of which 17 primarily affected the maxilla, and 15 the mandible. Associated injuries were to the brain (24%), torso (26%), upper limb (39%), and lower limb (31%). The number of maxillofacial injuries has risen over the last 7 years, and has also increased in proportion to the total number of injured soldiers evacuated between 2005 and 2007.

Antioxidant micronutrient impact on hearing disorders: concept, rationale, and evidence

Purpose Although auditory disorders are complex conditions, device-related modalities dominate current treatment. However, dysfunction from the central cortex to the inner ear apparatus is increasingly thought to be related to biochemical pathway abnormalities and to free radical–induced oxidative damage and chronic inflammation. Therefore, considering appropriate biologic therapy as an adjunct to standard care against these damaging factors may provide rational expansion of treatment options for otolaryngologists and audiologists. Methods This review outlines the biologic concepts related to some auditory and vestibular conditions and details the current rationale for utilizing antioxidants for a spectrum of hearing disorders. The strategy is based on the authors' collective experience in antioxidant science and supported with published research, pilot animal data and preliminary clinical observations. Results A comprehensive micronutrient approach was developed to exploit these pathways, and demonstrated safety and efficacy against oxidative damage and inflammation and clinically relevant neuroprotection. Cooperative research with Department of Defense institutions used prospective, randomized designs to show (1) reduction in oxidative damage measured in plasma and urine over six months, (2) protection against oxidative damage during 12 weeks of intense military training, (3) protection against inflammation after total body blast exposure (rodents), (4) strong neuroprotection against chemically-induced Parkinson's disease (rodents), (5) nerve VIII function improvement after concussive head injury in military personnel, and (6) tinnitus improvement in majority of patients after 90-day evaluation. Conclusion This systematic review of biologic strategies against hearing disorders combined with new animal and human observations may provide a rational basis for expanding current practice paradigms.

Challenges Associated with Post-Deployment Screening for Mild Traumatic Brain Injury in Military Personnel

There is ongoing debate regarding the epidemiology of mild traumatic brain injury (MTBI) in military personnel. Accurate and timely estimates of the incidence of brain injury and the prevalence of long-term problems associated with brain injuries among active duty service members and veterans are essential for (a) operational planning, and (b) to allocate sufficient resources for rehabilitation and ongoing services and supports. The purpose of this article is to discuss challenges associated with post-deployment screening for MTBI. Multiple screening methods have been used in military, Veterans Affairs, and independent studies, which complicate cross-study comparisons of the resulting epidemiological data. We believe that post-deployment screening is important and necessary—but no screening methodology will be flawless, and false positives and false negatives are inevitable. Additional research is necessary to refine the sequential screening methodology, with the goal of minimizing false negatives during initial post-deployment screening and minimizing false positives during follow-up evaluations.

Disentangling Mild Traumatic Brain Injury and Stress Reactions

The study by Hoge and colleagues in this issue of the Journal provides an important profile of the sequelae of mild traumatic brain injury in military personnel after combat.1 The findings demonstrate that mild traumatic brain injury results in increased rates of psychological, health, and functional problems. Although the study provides strong evidence for impairments in military personnel serving in Iraq and Afghanistan, it also raises a number of critical questions concerning the impairments that may be attributed to mild traumatic brain injury. One striking finding from this study is that although mild traumatic brain injury predicted a range of . . .

Acute Knee Injuries in Military Personnel: A Case-Control Study of the Effectiveness of Direct-Access Magnetic Resonance Imaging in a Primary Care Setting

To evaluate magnetic resonance (MR) imaging as a direct-access diagnostic tool for primary care physicians. Prospective, case-control study in a Royal Air Force setting. We obtained institutional review board approval and informed consent. Cases consisted of patients with acute knee injury and a physician-ordered MR scan. Controls were matched for gender, age, and knee injury and had MR investigation ordered by an orthopedic specialist. MR imaging cost $341 U.S. dollars per scan. Sixteen patients were enrolled, ages 17 to 44 years, and there were 48 controls. There was a significant intergroup difference for time to MR scan (p < 0.001), and no difference in time to specialist orthopedic assessment (p = 0.39). There was a significant intergroup difference (p < 0.001) in time to return to full fitness. Used as a primary care diagnostic tool and in settings where times to surgery are unacceptably long, direct-access MR imaging significantly decreases the amount of time to definitive treatment for military personnel with acute knee injuries. It may also improve clinical outcomes. MR imaging technology should be made more widely available in military primary care, including during mature combat missions.

Management of Skeletal Muscle Injuries in Military Personnel

Injuries to the musculoskeletal system, specifically skeletal muscle, are some of the most common injuries faced by military personnel today. Skeletal muscle trauma often results in significant loss of strength and flexibility, a propensity for recurrence of injury, and time off from military duty. The frequency of occurrence of skeletal muscle injuries and the poor outcomes associated with them decrease military readiness and increase monetary costs associated with treatment and lost work. Understanding the processes that occur in the muscle following injury allows a deeper grasp of potential therapeutic interventions to improve outcomes. Following trauma, the involved myofibers undergo 4 interrelated, time-dependent phases: degeneration, inflammation, regeneration, and fibrosis. Hematoma formation at the injury site is accompanied by infiltration of neutrophils, macrophages, and T-lymphocytes, as well as the release of multiple cytokines and growth factors from these infiltrating cells and from native myogenic cells. Regeneration is often accompanied by fibrosis, an overgrowth of fibroblast cells located within the connective tissue network. Skeletal muscle healing following trauma can be understood as a balance between fibrosis and regeneration. Fibrosis formation may lead to inadequate healing and an incomplete functional recovery of the muscle. Factors impacting this balance include inflammation, the growth factor and cytokine milieu at the site of injury, and the interaction between infiltrating inflammatory cells and native myogenic cells. Therapeutic interventions to improve outcomes following muscle injuries revolve around 3 concepts: enhancing regeneration, blocking fibrosis, and regulating inflammation.

The “Floating Ankle”: A Pattern of Violent Injury. Treatment with Thin-Pin External Fixation

The "floating ankle" is an underappreciated pattern of injury that results from violent trauma and/or blast injuries in military personnel. It is characterized by an intact ankle mortise with a distal tibia fracture and an ipsilateral foot fracture, creating instability around the ankle. This pattern of injury may be the result of the military boot, which both protects the foot from immediate amputation or further injury and renders the distal tibia susceptible to fracture at the boot top. Four patients with open floating ankle injuries were treated with thin-pin circular fixation with good results. Two patients required bone transport for segmental loss. All patients are ambulatory without assistance or bracing. Thin-pin external fixation is a reasonable approach to this complex injury pattern, especially in the presence of marked soft tissue compromise with or without segmental bone loss.