Combat orthopedic trauma

Introduction. Throughout history, military conflicts have provided an opportunity for worldwide medical lessons learned in a way that no peacetime situations can parallel. Operation Iraqi Freedom and Operation Enduring Freedom are no exceptions. This study aims to report the combat casualties seen at FOB Ghazni, a Role 2 facility in Afghanistan, during Operation Enduring Freedom from 1 January 2012 to 28 February 2013. Methods. The data was collected in an independent registry created here at FOB Ghazni. The database included operating room records, anesthesia records, and patient transfer data. Our patient population included all personnel (military and civilian) who sustained injuries during combat operations and were brought to our institution for evaluation and treatment. These patients all underwent operative intervention and transfer (with the exception of one intraoperative death) to a Role 3 facility for further care. Results. We identified 198 people with an average age of 27 years old. The mechanism of injury for 76 (38.4%) patients was high velocity gunshot wounds whereas 122 (61.6%) sustained blast injuries. 7 of the 76 gunshot-swounded patients also sustained injuries secondary to blast effects. 101 (50.1%) of our patients sustained musculoskeletal injuries and 69 (68.3%) of these patients required an operation. The mean NISS for orthopaedic patients was 33.2 (range 4-66). Lower extremity injuries occurred in 55 patients, upper extremity injuries in 29 patients, and pelvis injuries were identified in 8 patients. There was an average of 1.53 body regions involved (range 1-5). Orthopaedic procedures included three vascular reconstructions, four leg fasciotomies, 15 external fixator stabilizations, six K wire fixations, and one open reduction internal fixation. 44 patients underwent wound revision with debridement and irrigation. 24 of the 69 (33.8%) orthopaedic patients required other (nonorthopaedic) damage control operations. Conclusions. This study contributes FOB Ghazni’s experience to the building body of data that we can use at all levels of medical care to learn from and apply to improve combat casualty care. We emphasize the importance on the initial exam and appropriate prioritization of care based on solid ATLS principles as this no doubt saves lives. We continue to learn from past wars and we continue to evolve our care to improve survival rates.