Battlefield Orthopaedic Injuries Cause the Majority of Long-term Disabilities

Cross, Jason; Ficke, James R.; Hsu, Joseph R.; Masini, Brendan D.; Wenke, Joseph C.

doi:10.5435/00124635-201102001-00002

Cited by 208 publications

(190 citation statements)

References 10 publications

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“…The previously published cohort [6] of men analyzed 1333 combat-injured individuals, 450 of whom (34%) were medically retired or separated (unable to return to duty). The return-to-duty proportion is lower for combat-injured females (p = 0.003; RR, 1.425; 95% CI, 1.177-1.727).…”

Section: Resultsmentioning

confidence: 99%

“…There is no way to comment on the degree of subjectivity imposed on the PEB outcomes presented in this study; however, the VASRD and military standards for retention guidelines are intended to assure the PEB process is as objective as possible. Second, the comparison cohort of men is from a previously published work rather than collected in tandem with the cohort of women [6]. The previous cohort of men was used because it has been extensively studied.…”

Section: Discussionmentioning

confidence: 99%

“…Because records were not available for Navy personnel and the Marines, only Air Force and Army women service members were included. The women subjects were compared with a previously published cohort of men service members who were likewise entrants into DoDTR secondary to an injury sustained during deployment and who had at least one orthopaedic injury [6].…”

Section: Methodsmentioning

confidence: 99%

“…The disabling conditions for each subject were categorized by body system affected as described by Cross et al [6]. The conditions per body system were then analyzed as categorical data as a condition being ''present'' or ''not present'' for that body system.…”

Section: Methodsmentioning

confidence: 99%

“…Of the 368 women, 133 (36%) were injured in combat, whereas 235 (64%) were injured in nonbattle-deployed scenarios. The men comprising the control cohort consisted of 378 combat-injured service members derived from a prior cohort of 1333 soldiers, 450 of whom were medically retired as a result of their combat injuries [6]. Three hundred seventy-eight of the 450 men service members medically retired by the PEB had at least one orthopaedic injury, which allowed their inclusion for this study.…”

Section: Methodsmentioning

confidence: 99%

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Disability After Deployment Injury: Are Women and Men Service Members Different?

Rivera

Hylden

Johnson

2015

Clinical Orthopaedics &Amp; Related Research

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Background Civilian trauma literature suggests sexual dimorphism in outcomes after trauma. Because women represent an increasing demographic among veterans, the question remains if war trauma outcomes, like civilian trauma outcomes, differ between genders. Questions/purposes (1) Do women service members develop different conditions resulting in long-term disability compared with men service members after injuries sustained during deployment? (2) Do women service members have more or less severe disability after deployment injury compared with men service members? (3) Are men or women more likely to return to duty after combat injury?Methods The Department of Defense Trauma Registry was queried for women injured during deployment from 2001 to 2011. The subjects were then queried in the Physical Evaluation Board database to determine each subject's return-to-duty status and what disabling conditions and disability percentages were assigned to those who did not return to duty. Frequency of disabling conditions, disability percentages, and return-to-duty rates for 368 women were compared with a previously published cohort of 450 men service members, 378 of whom had orthopaedic injuries.Results Women who were unable to return to duty had a higher frequency of arthritic conditions (58% 378] of men, p = 0.0410; RR, 0.169; 95% CI, 0.023-1.224). Women had more severely rated posttraumatic stress disorder (PTSD) compared with men (38% ± 23% versus 19% ± 17%). Forty-eight percent (64 of 133) of battle-injured women were unable to return to active duty, resulting in a lower return-to-duty rate compared with men (34% [450 of 1333]; p = 0.003). Conclusions After deployment-related injury, women have higher rates of arthritis, lower rates of pain disorders, and more severely rated PTSD compared with men. Women are unable to return to duty more often than men injured in combat. These results suggest some difference between men's and women's outcomes after deployment injury, important information for military and Veterans Administration providers seeking to minimize postdeployment disability.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Disability After Deployment Injury: Are Women and Men Service Members Different?

Rivera

Hylden

Johnson

2015

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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Initial findings in traumatic peripheral nerve injury and repair with diffusion tensor imaging

Pridmore

Glassman

Pollins

et al. 2021

Ann Clin Transl Neurol

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Objective Management of peripheral nerve injuries requires physicians to rely on qualitative measures from patient history, electromyography, and physical exam. Determining a successful nerve repair can take months to years for proximal injuries, and the resulting delays in clinical decision‐making can lead to a negative impact on patient outcomes. Early identification of a failed nerve repair could prevent permanent muscle atrophy and loss of function. This study aims to test the feasibility of performing diffusion tensor imaging (DTI) to evaluate injury and recovery following repair of wrist trauma. We hypothesize that DTI provides a noninvasive and reliable assessment of regeneration, which may improve clinical decision‐making and alter the clinical course of surgical interventions. Methods Clinical and MRI measurements from subjects with traumatic peripheral nerve injury, carpal tunnel syndrome, and healthy control subjects were compared to evaluate the relationship between DTI metrics and injury severity. Results Fractional anisotropy from DTI was sensitive to differences between damaged and healthy nerves, damaged and compressed nerves, and injured and healthy contralateral nerves. Longitudinal measurements in two injury subjects also related to clinical outcomes. Implications of other diffusion measures are also discussed. Interpretation DTI is a sensitive tool for wrist nerve injuries and can be utilized for monitoring nerve recovery. Across three subjects with nerve injuries, this study has shown how DTI can detect abnormalities between injured and healthy nerves, measure recovery, and determine if re‐operation was successful. Additional comparisons to carpal tunnel syndrome and healthy nerves show that DTI is sensitive to the degree of impairment.

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Devitalized Stem Cell Microsheets for Sustainable Release of Osteogenic and Vasculogenic Growth Factors and Regulation of Anti‐Inflammatory Immune Response

et al. 2017

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The objective of this work was to investigate the effect of devitalized human mesenchymal stem cells (hMSCs) and endothelial colony-forming cells (ECFCs) seeded on mineralized nanofiber microsheets on protein release, osteogenesis, vasculogenesis, and macrophage polarization. Calcium phosphate nanocrystals were grown on the surface of aligned, functionalized nanofiber microsheets. The microsheets were seeded with hMSCs, ECFCs, or a mixture of hMSCs+ECFCs, cultured for cell attachment, differentiated to the osteogenic or vasculogenic lineage, and devitalized by lyophilization. The release kinetic of total protein, bone morphogenetic protein-2 (BMP2), and vascular endothelial growth factor (VEGF) from the devitalized microsheets was measured. Next, hMSCs and/or ECFCs were seeded on the devitalized cell microsheets and cultured in the absence of osteo-/vasculo-inductive factors to determine the effect of devitalized cell microsheets on hMSC/ECFC differentiation. Human macrophages were seeded on the microsheets to determine the effect of devitalized cells on macrophage polarization. Based on the results, devitalized undifferentiated hMSC and vasculogenic-differentiated ECFC microsheets had highest sustained release of BMP2 and VEGF, respectively. The devitalized hMSC microsheets did not affect M2 macrophage polarization while vascular-differentiated, devitalized ECFC microsheets did not affect M1 polarization. Both groups stimulated higher M2 macrophage polarization compared to M1.

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Battlefield Orthopaedic Injuries Cause the Majority of Long-term Disabilities

Cited by 208 publications

References 10 publications

Disability After Deployment Injury: Are Women and Men Service Members Different?

Disability After Deployment Injury: Are Women and Men Service Members Different?

Initial findings in traumatic peripheral nerve injury and repair with diffusion tensor imaging

Devitalized Stem Cell Microsheets for Sustainable Release of Osteogenic and Vasculogenic Growth Factors and Regulation of Anti‐Inflammatory Immune Response

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