Amputations in U.S. Military Personnel in the Current Conflicts in Afghanistan and Iraq

Stansbury, Lynn G.; Lalliss, Steven J.; Branstetter, Joanna G.; Bagg, Mark; Holcomb, John B.

doi:10.1097/bot.0b013e31815b35aa

Cited by 145 publications

(72 citation statements)

References 8 publications

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“…In total, only 103 (11%) servicemembers with amputation had a final rating of COAD, and 16 (2%) servicemembers with amputation had a final duty status of Fit ( Table 1). The mean age (24.0 yr), median rank (Enlisted 4) and percentage male (98.4%) demonstrated that this cohort was demographically consistent with previous studies of wounded servicemembers [3][4][10][11]. There were significantly more Air Force servicemembers with amputation found Fit than in other branches of service (p < 0.001), and no Marine or Navy servicemembers with amputation were found Fit.…”

Section: Resultssupporting

confidence: 70%

“…There has been a substantial number of amputations among U.S. servicemembers involved in OIF, OEF, and OND [3][4]10,[12][13]. Depending on severity, treatments rendered, and rehabilitation, many servicemembers are unable to return to Active Duty status following amputation [3][4]9].…”

Section: Discussionmentioning

confidence: 99%

“…The individual disabling conditions' ratings are combined into an overall disability rating, which determines eligibility for disability benefits once they are no longer on Active Duty status. All military personnel with a final disability rating above 75 are considered to be fully disabled and eligible for the maximum allotted disability payment [10]. RTD status, disabling conditions, disability ratings, military occupation status, and final total disability rating for each servicemember with amputation was gathered from each PEBLO.…”

Section: Methodsmentioning

confidence: 99%

“…All U.S. servicemembers who sustained a primary, major limb amputation (MLA) from October 1, 2001, through July 30, 2011, were identified by querying a military amputation database (MAD) (the Extremity Trauma and Amputation Center of Excellence; Joint Base Fort Sam Houston, Texas). MLA is defined as an amputation that occurs proximal to the carpals or tarsals of the affected limb [9][10]. Injury characteristics (Injury Severity Score [ISS], level of amputation) and demographic information (age, sex, military rank, branch of military service) were extracted for each servicemember with amputation(s).…”

Section: Methodsmentioning

confidence: 99%

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Identifying obstacles to return to duty in severely injured combat-related servicemembers with amputation

et al. 2015

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Abstract-The capacity of servicemembers with amputation to return to duty after combat-related amputation and the associated disabilities remains largely unknown. The purpose of this study was to examine the disabling conditions and return to duty rates of servicemembers with amputation across all service branches following major limb amputations from September 2001 through July 2011. Pertinent medical information, military occupation status, return to duty designation, disabling conditions, and disability ratings for each servicemember were obtained from the Physical Evaluation Board Liaison Office (PEBLO). Across all service branches, 16 (2%) servicemembers were found fit for duty (Fit) and allowed to continue with their preinjury occupation. Another 103 (11%) were allowed to continue on Active Duty (COAD) in a less physically demanding role. More than half (554, 56%) were determined fully disabled (PEBLO rating > 75); the average disability rating was 73. COAD and Fit Army servicemembers had lower Injury Severity Scores than other servicemembers (17.4, p = 0.009 and 11.2, p < 0.001, respectively). Despite improvements in their care and rehabilitation, only 13% of all servicemembers with amputation are able to return to Active Duty and many have multiple disabling conditions that contribute to a very high level of disability.

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Section: Resultssupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Identifying obstacles to return to duty in severely injured combat-related servicemembers with amputation

et al. 2015

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“…Extremity trauma accounts for over 70% of battlefield injuries [36] and is also the most common injury seen in civilian trauma centers. Morbidity is high when limb injury is complicated by ischemia, often resulting in residual disability or even amputation [26,32].…”

Section: Introductionmentioning

confidence: 99%

Can Cytoprotective Cobalt Protoporphyrin Protect Skeletal Muscle and Muscle-derived Stem Cells From Ischemic Injury?

Wilson

Welikson

Luo

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Extremity trauma is the most common injury seen in combat hospitals as well as in civilian trauma centers. Major skeletal muscle injuries that are complicated by ischemia often result in substantial muscle loss, residual disability, or even amputation, yet few treatment options are available. A therapy that would increase skeletal muscle tolerance to hypoxic damage could reduce acute myocyte loss and enhance preservation of muscle mass in these situations. Questions/purposes In these experiments, we investigated (1) whether cobalt protoporphyrin (CoPP), a pharmacologic inducer of cytoprotective heme oxygenase-1 (HO-1), would upregulate HO-1 expression and activity in skeletal muscle, tested in muscle-derived stem cells (MDSCs); and (2) whether CoPP exposure would protect MDSCs from cell death during in vitro hypoxia/reoxygenation. Then, using an in vivo mouse model of hindlimb ischemia/reperfusion injury, we examined (3) whether CoPP pharmacotherapy would reduce skeletal muscle damage when delivered after injury; and (4) whether it would alter the host inflammatory response to injury. Methods MDSCs were exposed in vitro to a single dose of 25 lL CoPP and harvested over 24 to 96 hours, assessing HO-1 protein expression by Western blot densitometry and HO-1 enzyme activity by cGMP levels. To generate hypoxia/reoxygenation stress, MDSCs were treated in vitro with phosphate-buffered saline (vehicle), CoPP, or CoPP plus an HO-1 inhibitor, tin protoporphyrin (SnPP), and then subjected to 5 hours of hypoxia (\ 0.5% O 2 ) followed by 24 hours of reoxygenation and evaluated for apoptosis. In vivo, hindlimb ischemia/reperfusion injury was produced in mice by unilateral 2-hour tourniquet application followed by 24 hours of reperfusion. In three postinjury treatment groups (n = 7 mice/group), CoPP was administered intraperitoneally during ischemia, at the onset of reperfusion, or 1 hour later. Two control groups of mice with the same injury received phosphatebuffered saline (vehicle) or the HO-1 inhibitor, SnPP. Myocyte damage in the gastrocnemius and tibialis anterior muscles was determined by uptake of intraperitoneally This work was funded by USAMRMC Award W81XWH-07-01-0246 (MDA) and USAMRMC Award W81XWH-10-01-0789 (MDA Results In MDSCs, a single exposure to CoPP increased HO-1 protein expression and enzyme activity, both of which were sustained for 96 hours. CoPP treatment of MDSCs reduced apoptotic cell populations by 55% after in vitro hypoxia/reoxygenation injury (from a mean of 57.3% apoptotic cells in vehicle-treated controls to 25.7% in CoPP-treated cells, mean difference 31.6%; confidence interval [CI], 28.1-35.0; p \ 0.001). In the hindlimb ischemia/reperfusion model, CoPP delivered during ischemia produced a 38% reduction in myocyte damage in the gastrocnemius muscle (from 86.4% ± 7% EBD + myofibers in vehicle-treated, injured controls to 53.2% EBD + in CoPP-treated muscle, mean difference 33.2%; 95% CI, 18.3, 48.4; p \ 0.001). A 30% reduction in injury to the gastrocnemius was seen with drug...

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Pharmacologic interventions for treating phantom limb pain

Alviar

Hale

Dungca³

2016

Cochrane Database of Systematic Reviews

135

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Since the last version of this review, we identified another study that added another form of medical therapy, BoNTs, specifically BoNT/A, to the list of pharmacologic interventions being reviewed for clinical efficacy in phantom limb pain. However, the results of this study did not substantially change the main conclusions. The short- and long-term effectiveness of BoNT/A, opioids, NMDA receptor antagonists, anticonvulsants, antidepressants, calcitonins, and local anaesthetics for clinically relevant outcomes including pain, function, mood, sleep, quality of life, treatment satisfaction, and adverse events remain unclear. Based on a small study, BoNT/A (versus lidocaine/methylprednisolone) does not decrease phantom limb pain. Morphine, gabapentin, and ketamine demonstrate favourable short-term analgesic efficacy compared with placebo. Memantine and amitriptyline may not be effective for PLP. However, results must be interpreted with caution, as they were based mostly on a small number of studies with limited sample sizes that varied considerably and also lacked long-term efficacy and safety outcomes. The direction of efficacy of calcitonin, local anaesthetics, and dextromethorphan needs further clarification. Overall, the efficacy evidence for the reviewed medications is thus far inconclusive. Larger and more rigorous randomised controlled trials are needed for us to reach more definitive conclusions about which medications would be useful for clinical practice.

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Amputations in U.S. Military Personnel in the Current Conflicts in Afghanistan and Iraq

Abstract: Overall, major limb amputation rates for the current U.S. engagement in Afghanistan and Iraq are similar to those of previous conflicts.

Cited by 145 publications

References 8 publications

Identifying obstacles to return to duty in severely injured combat-related servicemembers with amputation

Identifying obstacles to return to duty in severely injured combat-related servicemembers with amputation

Can Cytoprotective Cobalt Protoporphyrin Protect Skeletal Muscle and Muscle-derived Stem Cells From Ischemic Injury?

Pharmacologic interventions for treating phantom limb pain

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