Pain, Depression, and Posttraumatic Stress Disorder Following Major Extremity Trauma Among United States Military Serving in Iraq and Afghanistan: Results From the Military Extremity Trauma and Amputation/Limb Salvage Study.

Objectives: Assess the burden and co-occurrence of pain, depression, and posttraumatic stress disorder (PTSD) among service members who sustained a major limb injury, and examine whether these conditions are associated with functional outcomes.

Design: A retrospective cohort study.

Setting: Four U.

The Military Extremity Trauma Amputation/Limb Salvage (METALS) study: outcomes of amputation versus limb salvage following major lower-extremity trauma.

Background: The study was performed to examine the hypothesis that functional outcomes following major lower-extremity trauma sustained in the military would be similar between patients treated with amputation and those who underwent limb salvage.

Methods: This is a retrospective cohort study of 324 service members deployed to Afghanistan or Iraq who sustained a lower-limb injury requiring either amputation or limb salvage involving revascularization, bone graft/bone transport, local/free flap coverage, repair of a major nerve injury, or a complete compartment injury/compartment syndrome. The Short Musculoskeletal Function Assessment (SMFA) questionnaire was used to measure overall function.

Bone transport combined with locking bridge plate fixation for the treatment of tibial segmental defects: a report of 2 cases.

Segmental tibial bone loss, specifically in the setting of high-energy trauma, presents a challenging problem to the treating orthopaedic surgeon. These injuries are often complicated by tissue loss, poor wound healing, and infection. Many techniques of reconstruction have been advocated from bone grafting to bone transport.

Combat-related pelvis fractures in nonsurvivors.

Background: The purpose of this study was to describe pelvic fractures and their associated injuries in service members who either died of wounds or were killed in action during Operation Iraqi Freedom and Operation Enduring Freedom and define any differences in associated injuries between penetrating versus blunt injury to the pelvis.

Methods: A review of all service members who sustained a pelvis fracture during Operation Iraqi Freedom and Operation Enduring Freedom in the year 2008 was performed. Data were recorded for analysis.

Advances in the care of battlefield orthopaedic injuries.

Musculoskeletal wounds are the most common type of injury among survivors of combat trauma. The treatment of these wounds entails many challenges. Although methods of care are evolving, significant gaps remain as knowledge of civilian trauma is extrapolated to combat injuries.

Orthopaedic war injuries: recent developments in treatment and research.

Musculoskeletal injury is the most common type of injury among survivors of combat trauma, and combat-related trauma is challenging for an orthopaedic surgeon to treat. Methods of treatment are evolving, but significant gaps remain as knowledge of civilian trauma is extrapolated to combat trauma.

Thermal necrosis complicating reamed intramedullary nailing of a closed tibial diaphysis fracture: a case report.

A case report of thermal necrosis of the tibia after reamed intramedullary nailing is presented. Given the consequences of this complication, the proper use of reaming technique and equipment is emphasized.

From Iraq back to Iraq: modern combat orthopaedic care.

War wounds are often large and complex, with high degrees of contamination and tissue loss differing significantly from typical civilian injuries. Infection has been a common complication driving the tenets of care, even in the antibiotic age. Fractures were historically treated with casting or traction because of the risk of infection with internal fixation.

Orthopaedic war injuries: from combat casualty care to definitive treatment: a current review of clinical advances, basic science, and research opportunities.

Musculoskeletal war wounds often involve massive injury to bone and soft tissue that differ markedly in character and extent compared with most injuries seen in civilian practice. These complex injuries have challenged orthopaedic surgeons to the limits of their treatment abilities on the battlefield, during medical evacuation, and in subsequent definitive or reconstructive treatment. Newer methodologies are being used in the treatment of these wounds to prevent so-called second hit complications, decrease complications associated with prolonged medical evacuation, reduce the incidence of infection, and restore optimal function.

Displaced apophyseal olecranon fracture in a healthy child.

Olecranon apophyseal fractures in children are uncommon. The bulk of these injuries are nondisplaced and therefore can be treated nonoperatively. Few published reports of children with displaced fractures of the olecranon apophysis exist, and the large majority of reports describe children with osteogenesis imperfecta.

The scope of wounds encountered in casualties from the global war on terrorism: from the battlefield to the tertiary treatment facility.

Injuries seen in Operation Iraqi Freedom range from those that can be managed with nonsurgical wound care only to those requiring amputation or multiple bony and soft-tissue procedures for limb salvage. The contamination and soft-tissue injury caused by exploding ordnance requires an aggressive treatment approach. Severe wounds treated near the battlefield (ie, level II) require meticulous surgical débridement, early fracture stabilization, broad-spectrum antibiotics, and rapid evacuation.

Extension block pinning for large mallet fractures.

Purpose: The purpose of this report is to review the results of displaced mallet fractures treated with an extension block pin and transarticular fixation of the distal interphalangeal joint.

Methods: We retrospectively reviewed 23 patients with 24 fractures to determine the results of treatment, time to union, range of motion, and associated complications.

Results: The average patient age was 24 years and the average fracture size was 40% of the joint surface.

Successful reimplantation of a large segment of femoral shaft in a type IIIA open femur fracture: a case report.

Segmental bone loss associated with high-energy open fractures is a difficult problem. The more perplexing and controversial problem is that faced when the extruded segment of bone is retrieved from the field and available for potential reimplantation. Here we present successful reimplantation of a 13-cm segment of meta-diaphyseal femur in a 15-year-old boy.

Extension-block pinning for treatment of displaced mallet fractures.

Mallet injuries are common in active individuals, particularly those who participate in sports such as basketball and football. Although a majority of patients with displaced mallet fractures are treated conservatively with extension splinting, their treatment is often complicated by residual loss of extension and fracture displacement secondary to unfavorable fracture biomechanics and poor patient compliance. An attractive alternative to nonoperative treatment is the minimally invasive technique of extension-block percutaneous pinning.