Military Orthopaedic Wound Management and Amputee Care Best Practices Established

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Extremity War Injuries Symposium publication prioritizes combat-related musculoskeletal research.

Extremity War Injuries: State of the Art and Future Directions.

Today the number of American soldiers wounded in action in Iraq and Afghanistan exceeds 9,700. This is a different kind of war, and so are the wounds it creates. More than 50 percent of the wounded have suffered musculoskeletal injuries, many made more challenging by the effects of improvised explosive devices (IEDs) or vehicle-borne improvised explosive devises (VBIEDs), which are distinct from domestic injuries. Traditional wound management guidelines simply fall short.

To address this need, the American Academy of Orthopaedic Surgeons (AAOS) and the Orthopaedic Trauma Association (OTA) have issued a special edition of the Journal of the American Academy of Orthopaedic Surgeons: “Extremity War Injuries: State of the Art and Future Directions.”

In January 2006, AAOS and OTA hosted the first Extremity War Injuries (EWI) symposium in Washington DC, which defined current knowledge of the management of extremity war wounds. AAOS and OTA fellows worked with military orthopaedic surgeons to address wound management, antibiotics and infection, long-bone stabilization, management of segmental bone defects and amputee care. The symposium findings include a prioritized list of research objectives.

“We learned through the symposium how necessary it is for more research to help our military orthopaedic surgeons decide how to best treat these complex injuries,” said Andrew N. Pollak, MD, chief of orthopaedic trauma at the R Adams Cowley Shock Trauma Center at the University of Maryland, member of AAOS’ Board of Directors and co-chair of the EWI Symposium. “Our military counterparts are doing an outstanding job of treating these severe injuries, and we need to help them by directing research to provide them with some answers about how to better manage these injuries as soon as possible.”

The symposium resulted in a request to Congress for additional federal funding for EWI research through the Department of Defense to offer our wounded soldiers better healing outcomes and daily living capabilities.

“I am constantly amazed at the dedication of these military surgeons,” noted Jason Calhoun, MD, chairman, J. Vernon Luck Distinguished Professor in the Department of Orthopaedic Surgery at the University of Missouri-Columbia, and co-chair of the EWI Symposium. "Military surgeons and patients are pushing the envelope on treatment, research and knowledge on blast injuries through extremity injury and infection, reconstruction, amputation and rehabilitation that already has and will continue to dramatically improve our treatment of trauma in the civilian population as well.”

The second Symposium will be held in Washington, DC in January 2007. For more information or to access the special edition, please visit http://www.jaaos.org.

An orthopaedic surgeon is a physician with extensive training in the diagnosis and treatment of non-surgical as well as surgical treatment of the musculoskeletal system including bones, joints, ligaments, tendons, muscles and nerves.

The Orthopaedic Trauma Association (http://www.ota.org) is a not-for-profit organization that promotes excellence in orthopaedic trauma patient care at hospitals and trauma centers throughout North America. Its members provide worldwide leadership through education, research and patient advocacy.

With 29,000 members, the American Academy of Orthopaedic Surgeons (http://www.aaos.org) or (http://www.orthoinfo.org), is a not-for-profit organization that provides education programs for orthopaedic surgeons, allied health professionals and the public. An advocate for improved patient care, the Academy is participating in the Bone and Joint Decade (http://www.usbjd.org), the global initiative in the years 2002-2011 to raise awareness of musculoskeletal health to stimulate research and improve people's quality of life. President Bush has declared the years 2002-2011 National Bone and Joint Decade in support of these objectives. The Academy’s 74th Annual Meeting is being held February 14-18, 2007 in San Diego.

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