Cervical and Thoracolumbar Spine Injury Evaluation, Transport, and Surgery in the Deployed Setting.

This Cervical and Thoracolumbar Spine Injury Evaluation, Transport, and Surgery Clinical Practice Guideline (CPG) is designed to provide guidance to the deployed provider when they are treating a combat casualty who has sustained a spine or spinal cord injury. The CPG objective for the treatment and the movement of these patients is to maintain spinal stability through transport, perform decompression when urgently needed, achieve definitive stabilization when appropriate, avoid secondary injury, and prevent deterioration of the patient's neurological condition. Thorough and accurate documentation of the patient's neurological examination is crucial to ensure appropriate management decisions are made as the patient transits through the evacuation system.

Gender Disparities Within US Army Orthopedic Surgery: A Preliminary Report.

Introduction: Women account for approximately 15% of the active duty US Army, and studies show that women may be at an increased risk of musculoskeletal injury during sport and military training. Nationally, the field of orthopedic surgery comprises 14% women, lagging behind other surgical fields. Demographics for US Military orthopedic surgeons are not readily available.

The effect of preoperative lumbar epidural corticosteroid injection on postoperative infection rate in patients undergoing single-level lumbar decompression.

Background Context: Lumbar epidural corticosteroid injections (LECIs) are frequently used in the treatment of lumbar intervertebral disc herniation with radiculopathy and lumbar spinal stenosis. Although widely used, their effect on the outcomes and complications of subsequent surgery is unclear. Postoperative infection can be a morbid complication following spine surgery, and recent literature has suggested that the risk may be increased in patients undergoing lumbar spinal surgery who had previously received LECIs.

The effect of cervical posterior foraminotomy on segmental range of motion in the setting of total disc arthroplasty.

Study Design: Human cadaveric biomechanical analysis.

Objective: To investigate the effect on cervical spine segmental stability that results from a posterior foraminotomy after cervical disc arthroplasty (CDA).

Summary Of Background Data: Posterior foraminotomy offers the ability to decompress cervical nerves roots while avoiding the need to extend a previous fusion or revise an arthroplasty to a fusion.

Systematic review and meta-analysis of minimally invasive transforaminal lumbar interbody fusion rates performed without posterolateral fusion.

The need for posterolateral fusion (PLF) in addition to interbody fusion during minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF) has yet to be established. Omitting a PLF significantly reduces overall surface area available for achieving a solid arthrodesis, however it decreases the soft tissue dissection and costs of additional bone graft. The authors sought to perform a meta-analysis to establish the fusion rate of MIS TLIF performed without attempting a PLF.

Comparison of functional outcomes following bridge synostosis with non-bone-bridging transtibial combat-related amputations.

Background: The prevalence of penetrating wartime trauma to the extremities has increased in recent military conflicts. Substantial controversy remains in the orthopaedic and prosthetic literature regarding which surgical technique should be performed to obtain the most functional transtibial amputation. We compared self-reported functional outcomes associated with two surgical techniques for transtibial amputation: bridge synostosis (modified Ertl) and non-bone-bridging (modified Burgess).

Blast-induced lower extremity fractures with arterial injury: prevalence and risk factors for amputation after initial limb-preserving treatment.

Objectives: The purpose of this study is to determine the rate of late (secondary) amputation and to identify risk factors for amputation in injuries that were initially treated with limb preservation on the battlefield.

Methods: A retrospective review at our institution identified 24 consecutive patients with 26 blast-induced open fractures distal to the joint that had associated arterial injuries. All injuries were initially cared for on the battlefield and during the evacuation chain of care with limb preservation protocols.

Early motion protocol for select Galeazzi fractures after radial shaft fixation.

Galeazzi fractures traditionally are treated in long arm casts with the wrist fully supinated for 6 weeks after open reduction and internal fixation. Recent literature suggests that early motion can be permitted for a subset of Galeazzi fractures. Defining a safe postoperative protocol that allows immediate elbow motion, immediate platform weight bearing, and early wrist motion might decrease elbow morbidity, increase range of motion, and improve outcomes.

Soft tissue coverage of combat wounds.

Warfare-related open fractures with large soft tissue defects create a significant reconstructive challenge. The objective of this article is to review current and evolving treatment strategies for soft tissue coverage of warfare-induced extremity wounds. A review of previously published literature and current data evaluating combat-injured personnel requiring extremity flap reconstruction performed by a single surgeon within the National Capital Area from 2004 to 2009 was performed.

Effective lordosis: analysis of sagittal spinal canal alignment in cervical spondylotic myelopathy.

Object: Analysis of cervical sagittal deformity in patients with cervical spondylotic myelopathy (CSM) requires a thorough clinical and radiographic evaluation to select the most appropriate surgical approach. Angular radiographic measurements, which are commonly used to define sagittal deformity, may not be the most appropriate to use for surgical planning. The authors present a simple straight-line method to measure effective spinal canal lordosis and analyze its reliability.

A comparison of open versus arthroscopic harvesting of osteochondral autografts.

Osteochondral autograft transfer is a technique for treatment of traumatic and degenerative cartilage lesions. A graft in which the cartilage cap is oriented perpendicular to the long axis of the graft is ideal because it can both restore the cartilage tidemark and minimize articular step-off at the recipient site. This study determines if osteochondral harvest technique (arthroscopic versus mini-open) or donor site location affects suitable graft harvest.

Short-term outcomes of severe open wartime tibial fractures treated with ring external fixation.

Background: The treatment of complex open tibial fractures sustained in combat remains controversial. This study investigated the short-term outcomes of type-III tibial shaft fractures treated at our institution with ring external fixation.

Methods: A retrospective review identified sixty-seven type-III tibial shaft fractures in sixty-five consecutive patients treated between April 2004 and January 2007.

Perioperative differences between bone bridging and non-bone bridging transtibial amputations for wartime lower extremity trauma.

Background: The distal bone bridge transtibial amputation technique requires additional intraoperative surgical steps when compared to the non-bone bridging technique. Comparative functional data is not available showing a clearly superior outcome from either technique. Identifying perioperative differences could influence a surgeon's decision regarding the technique of amputation to be performed.