A Military-Civilian Training Partnership for Army Nurses.

Background: In 2018, the U.S. Army Surgeon General created the Army Medical Department Military-Civilian Trauma Team Training (AMCT3) program to enhance the clinical proficiency of medical personnel serving on Army trauma teams called forward resuscitative surgical detachments (FRSDs).

Recent Orthopedic Trauma Volume in the United States Military Health System.

Introduction: As illustrated by the "Walker Dip," there is growing concern regarding the lack of combat casualty care during peacetime. Surgical volume and case complexity are paramount for training and skill sustainment. We sought to quantify the recent orthopedic trauma surgical case load of all military orthopedic surgeons across the Military Health System (MHS).

Intraoperative Cardiac Arrest in Orthopaedic Surgery: A Case Series of 42 Patients.

Introduction: Intraoperative cardiac arrest (IOCA) is a rare event during orthopaedic surgery. Although infrequent, it has a notable effect, with mortality as high as 35%. Little is known about the outcomes of IOCA in orthopaedic surgery, and this study aims to fill that knowledge gap to improve patient counseling and treatment decisions.

What is the Case Volume of Orthopaedic Trauma Surgeons in the Military Health System? An Assessment of Wartime Readiness and Skills Sustainment.

Introduction: Complex, high-energy extremity trauma secondary to explosive mechanisms has been increasingly common in modern warfare, accounting for a majority of combat wounds throughout the conflicts in Iraq and Afghanistan. Fellowship-trained orthopaedic trauma surgeons treated many of these complex injuries; however, as the number of casualties continue to decrease during a period of relative peace, a growing concern over maintaining military trauma readiness exists.

Methods: The Military Health System Data Repository was queried for all Common Procedural Terminology (CPT) codes associated with 18 fellowship-trained orthopaedic trauma surgeons from 2013 to 2019.

Optimizing Advanced Trauma Life Support (ATLS®) to Maximize Readiness.

Introduction: The Army utilizes Individual Critical Task Lists (ICTLs) to track and ensure competency and deployment readiness of its medical service members. ICTLs are the various skills and procedures that the Army has deemed foundational for each area of concentration (AOC)/military occupational specialty (MOS). While many ICTLs involve the patient care that military medical providers regularly provide, some procedures are not as commonly performed.

World War I and the Thomas Splint: A Historical Review.

The Thomas splint, the first practical traction splint for femoral fractures, revolutionized the capabilities of military medicine. Its usage in WWI lowered the mortality rate from 80% to nearly 15%. Its development not only shaped modern orthopedics but also established the splint as standard equipment in hospitals worldwide.

Water Decontamination Products for Wound Irrigation in Austere Environments: Benchtop Evaluation and Recommendations.

Background: Irrigation is used to minimize infection of open wounds. Sterile saline is preferred, but potable water is becoming more widely accepted. However, the large volumes of water that are recommended are usually not available in austere environments.

Perioperative nutritional status thought to be important, but poorly understood.

Objectives: Malnutrition has been shown to increase complications and leads to poor outcomes in surgical patients, but it has not been studied extensively in orthopedic trauma. This study's purpose is to determine the perspective and assessment of nutrition by orthopedic traumatologists.

Methods: A survey was created and distributed via REDCap to orthopedic traumatologists at 60 U.

Bluetooth Tactical Headsets Improve The Speed of Accurate Patient Handoffs.

Background: The Committee on En Route Combat Casualty Care recently ranked the patient handoff as their fourth research priority. Bluetooth technology has been introduced to the battlefield and has the potential to improve the tactical patient handoff. The purpose of this study is to compare the traditional methods of communication used in tactical medical evacuation by Special Operations medical personnel (radio push-to-talk [PTT] and Tactical Medic Intercom System [TM-ICS]) to Bluetooth communication.

Negative pressure wound therapy: Where are we in 2022?

The use of negative pressure wound therapy (NPWT) continues to be an important tool for surgeons. As the use and general acceptance of NPWT have grown, so have the indications for its use. These indications have expanded to include soft tissue defects in trauma, infection, surgical wound management, and soft tissue grafting procedures.

Patient Mental Health and Well-being: Its Impact on Orthopaedic Trauma Outcomes.

A patient's mental health can have a significant impact on their orthopaedic trauma outcome. It is important for orthopaedic surgeons to identify patients at risk for a poor outcome based on their mental health, to include the presence of post-traumatic stress disorder, depression, and anxiety, among others. Although some behaviors such as catastrophizing have been associated with worse outcomes, others, such as possessing greater self-efficacy have been associated with improved outcomes.

Trauma System Support to Facilitate Recovery.

Trauma is a major public health issue. Orthopaedic trauma surgeons are skilled in the acute management of musculoskeletal injury; however, formal training and resources have not been devoted to optimizing recovery after trauma. Recovery entails addressing the biomedical aspects of injury, as well as the psychological and social factors.

Building a sustainable Mil-Civ partnership to ensure a ready medical force: A single partnership site's experience.

One of the challenges in military medicine is ensuring that the medical force deployed to the theater of combat operations is prepared to perform life, limb, and eyesight saving care at a level of care comparable to our top civilian Level I trauma centers. There is increasingly more evidence demonstrating that the majority of military physicians are not exposed to trauma or combat casualty care-relevant surgical cases on a consistent basis in their daily practice at their garrison military treatment facility (MTF). To prevent this widening skills and experience gap from become more of a reality, the 2017 National Defense Authorization Act called for the expansion of military and civilian (Mil-Civ) medical partnerships, working toward embedding military medical providers and surgical teams in busy civilian trauma centers.

Adaptation of the Centers for Disease Control Surgical Wound Classification System for Orthopaedic Trauma Surgery.

Objectives: To evaluate a proposed orthopaedic-specific surgical wound classification system (SWCS) and the current Centers for Disease Control (CDC) system in a series of detailed clinical vignettes and to identify the degree of satisfaction with CDC SWCS and desire for institution of an orthopaedic-specific SWCS.

Methods: Forty-five clinical vignettes and a 5-question survey were distributed to current and past members of the Orthopaedic Trauma Association's Classification Committee. Respondents were asked to provide wound class for each vignette using the CDC system and orthopaedic-specific SWCS.

Preoperative and Intraoperative Considerations Using Intramedullary Nails for the Treatment of Tibial Shaft Fractures Below Total Knee Arthroplasty.

Periprosthetic tibial shaft fractures below total knee arthroplasty (TKA) are relatively rare, with an incidence of approximately 1%. However, as the rates of arthroplasty increase, orthopaedic surgeons are likely to see a corresponding increase in these types of fractures. Native tibial shaft fractures are routinely treated with either nails or plates, and the success of intramedullary nailing of tibial shaft fractures has been well described in the literature.

Defining Incidence of Acute Compartment Syndrome in the Research Setting: A Proposed Method From the PACS Study.

Objective: To compare the retrospective decision of an expert panel who assessed likelihood of acute compartment syndrome (ACS) in a patient with a high-risk tibia fracture with decision to perform fasciotomy.

Design: Prospective observational study.

Setting: Seven Level 1 trauma centers.

Early Advanced Weight-Bearing After Periarticular Fractures: A Randomized Trial Comparing Antigravity Treadmill Therapy Versus Standard of Care.

In current clinical practice, weight-bearing is typically restricted for up to 12 weeks after definitive fixation of lower extremity periarticular fractures. However, muscle atrophy resulting from restricting weight-bearing has a deleterious effect on bone healing and overall limb function. Antigravity treadmill therapy may improve recovery by allowing patients to safely load the limb during therapy, thereby reducing the negative consequences of prolonged non-weight-bearing while avoiding complications associated with premature return to full weight-bearing.

Prevalence of Individual Differences in Tibial Torsion: A CT-Based Study.

Objectives: To measure baseline bilateral tibial torsion in a cohort of uninjured patients to assess for a difference in torsion between sides.

Methods: Consecutive bilateral lower extremity CT angiography scans from 229 patients without tibial or fibular pathology were collected and reviewed. Torsion of each tibia was measured by two independent reviewers, and individual differences in torsion were calculated.

Biomechanical evaluation of a tool-less external fixator.

Introduction: Current external fixator systems used by the US and UK military for stabilising extremity fractures require specialised tools to build a construct. The goal of obtaining and maintaining limb length and alignment is not achieved if these tools are misplaced. An alternative, tool-less system is currently available, namely the Dolphix Temporary Fixation System.