Management Of Combat-related Injuries Research Articles

Combat-related acetabular fractures: Outcomes of open versus closed injuries

IntroductionSince the onset of the Global War on Terror close to 50,000 United States service members have been injured in combat, many of these injuries would have previously been fatal. Among these injuries, open acetabular fractures are at an increased number due to the high percentage of penetrating injuries such as high velocity gunshot wounds and blast injuries. These injuries lead to a greater degree of contamination, and more severe associated injuries. There is a significantly smaller proportion of the classic blunt trauma mechanism typically seen in civilian trauma. MethodsWe performed a retrospective review of the Department of Defense Trauma Registry into which all US combat-injured patients are enrolled, as well as reviewed local patient medical records, and radiologic studies from March 2003 to April 2012. Eighty seven (87) acetabular fractures were identified with 32 classified as open fractures. Information regarding mechanism of injury, fracture pattern, transfusion requirements, Injury Severity Score (ISS), and presence of lower extremity amputations was analyzed. ResultsThe mechanism of injury was an explosive device in 59% (n=19) of patients with an open acetabular fracture; the remaining 40% (n=13) were secondary to ballistic injury. In contrast, in the closed acetabular fracture cohort 38% (21/55) of fractures were due to explosive devices, and all remaining (n=34) were secondary to blunt trauma such as falls, motor vehicle collisions, or aircraft crashes. Patients with open acetabular fractures required a median of 17units of PRBC within the first 24h after injury. The mean ISS was 32 in the open group compared with 22 in the closed group (p=0.003). In the open fracture group nine patients (28%) sustained bilateral lower extremity amputations, and 10 patients (31%) ultimately underwent a hip disarticulation or hemi-pelvectomy as their final amputation level. DiscussionOpen acetabular fractures represent a significant challenge in the management of combat-related injuries. High ISS and massive transfusion requirements are common in these injuries. This is one of the largest series reported of open acetabular fractures. Open acetabular fractures require immediate damage control surgery and resuscitation as well as prolonged rehabilitation due to their severity. The dramatic number of open acetabular fractures (37%) in this review highlights the challenge in treatment of combat related acetabular fractures.

Noncombat-related injuries or illnesses incurred by military working dogs in a combat zone.

To determine the most common types of noncombat-related injuries or illnesses in military working dogs in a combat zone. Retrospective descriptive study. 1,350 patient encounters with military working dogs evaluated for noncombat-related reasons. Data regarding noncombat-related veterinary visits were collected on a weekly basis from 13 forward operating bases throughout Iraq from January 2009 through August 2010. Reporting facility location, patient identification, reason for evaluation, diagnosis, and treatment were recorded, and descriptive data were summarized. The most common noncombat-related disease processes or injuries identified were related to the dermatologic system (ie, primary [inflammatory] dermatologic disease; 338/1,350 [25.0%]), soft tissue trauma (284 [21.0%]), alimentary system (231 [17.1%]), or musculoskeletal system (193 [14.3%]). Veterinary Corps officers need to be proficient not only in the management of combat-related injuries but also in the treatment of routine illnesses and injuries. Knowledge of noncombat-related diseases and injuries commonly incurred by military working dogs can be used for targeted training for individuals responsible for medical care of these animals as well as for equipment selection and protocol development.