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A salute to orthopaedics and the military

By Tony Rankin, MD

Recently, I attended the 50th anniversary of the Society of Military Orthopaedic Surgeons (SOMOS). As a former Army officer who received my orthopaedic training in the military at Walter Reed General Hospital (now Walter Reed Army Medical Center), I felt a sense of homecoming. It was a privilege and an honor to have received my orthopaedic training in the military and to have served my country at home and abroad.

The strong association between the development of orthopaedic surgery in America and the military dates back to World War I, as noted by Henry H. Sherk, MD, in the history he prepared for the Academy’s 75th Anniversary, Getting It Straight: A History of American Orthopaedics. The specialty received another boost when Norman T. Kirk, MD, an orthopaedic surgeon, was appointed Surgeon General of the Army in 1943.

Tony Rankin, MD

I was especially intrigued to read about the possible reason for General Kirk’s appointment. President Franklin Delano Roosevelt, who had contracted polio as a young man, spent much time in Warm Springs, Georgia, under the care of Michael Hoke, MD, who was also an orthopaedic surgeon and a colleague of Dr. Kirk. According to Dr. Sherk, the president’s illness and subsequent relationship with an orthopaedic surgeon led him to believe “that orthopaedists cared more about an individual’s outcome than whether they merely lived or died. This quality of orthopaedics and the nature of the specialty made its practitioners regard ‘crippled’ persons in a different light. This gave people the hope that they could bounce back from illness or injury, earn a living, and live with self-respect.”

That quality and that hope continue today. No other specialty has a comparable ability to improve the quality of life for patients—whether they are children injured on a playground, young athletes temporarily taken “out of the game,” baby boomers attempting to hold on to their youth and overdoing their weekend workouts, the elderly who want to maintain their independence, or soldiers injured on the battlefield.

Making “wounded warriors” whole
The influence of World War II on the field of orthopaedic surgery can be measured in several ways, including the medical advances that were made. Armed conflicts have always resulted in injuries to the musculoskeletal system, and the subsequent advances in treatment have benefited both civilian and military populations.

For example, during World War II, mortality rates for soldiers with extremity wounds were much lower than those in WW I, in part due to the efforts of orthopaedic surgeons. Advances in care have continued to improve survival rates—from less than 70 percent in WW II to more than 90 percent today—even as the musculoskeletal trauma inflicted by improvised explosive devices and other weapons has increased.

Conflicts in Korea and Vietnam resulted in the development of the Army Aeromedical Evacuation system. Rapid transport of the injured from the battlefield to definitive care resulted in more lives being saved. The knowledge gained from the military on transportation of the acutely injured was then applied in civilian trauma centers.

The present conflicts in Iraq and Afghanistan have seen significant collaboration between the military and the AAOS. Beginning in 2006 in collaboration with the Orthopaedic Trauma Association (OTA) and in cooperation with the military, the AAOS instituted an annual symposia series, Extremity War Injuries (EWI). In 2008, SOMOS joined the AAOS and the OTA as a sponsor. These symposia have served to define current knowledge regarding management of extremity war injuries for the National Institutes of Health, Congress, the Department of Defense, orthopaedic surgeons, researchers, industry, and other relevant governmental agencies.

EWI-IV was held Jan. 21–23 in Washington, D.C., and focused on collaborative efforts in research, host nation care, and disaster preparedness. I strongly believe that the research being done in tissue repair, scaffolds and cell therapies for bone defect repair, nerve repair, and limb salvage will have significant application for all orthopaedists and their patients.

Measures of success
In examining the links between the military and orthopaedic surgery, we must consider more than just the medical advances. In the 30 years following WWII, most of the Academy’s leaders were veterans. The leadership training provided by the military enabled these orthopaedists to build a strong, forward-looking Academy.

That tradition continues today. The AAOS and the OTA have established the Landstuhl Visiting Scholars Program to facilitate an exchange of ideas between civilian and military orthopaedic trauma surgeons and to provide educational opportunities to military surgeons serving in Germany, enabling them to earn continuing education credits and benefit from the knowledge and experience of their civilian counterparts.

To date, 20 dedicated physicians have participated in this program—“the ultimate volunteer experience,” as COL (ret) Roman A. Hayda, MD, and Michael J. Bosse, MD, described it in the December 2008 AAOS Now. These volunteers will be formally recognized during the Opening Ceremonies of the 2009 Annual Meeting in Las Vegas.

A more concrete, dollars-and-cents measure of success should also be acknowledged. The AAOS has made a significant investment for outside lobbyists to assist our office of government relations to create new research funding for extremity war injuries. The coordinated efforts of the AAOS, OTA, and SOMOS have helped to secure $66 million dollars in support of peer-reviewed orthopaedic trauma research in the 2009 fiscal year budget. This represents the largest single increase in the annual federal investment in musculoskeletal research.

The military has had a tremendous influence on our specialty of orthopaedic surgery, of which we can all be proud. To learn more, I encourage you to attend the symposium on “Advances in the Care of Battlefield Orthopaedic Trauma” at 4 p.m. on Thursday, Feb. 26, during the 2009 AAOS Annual Meeting.

Final notes
At the SOMOS meeting, I received a plaque engraved with the following sentiment—originally penned by Father Dennis E. O’Brien, a sergeant in the U.S. Marine Corps. The words give us all food for thought, and I would like to share them here.

“It is the soldier, not the reporter, who has given us freedom of the press. It is the soldier, not the poet, who has given us freedom of speech. It is the soldier, not the campus organizer, who has given us the freedom to demonstrate. It is the soldier, who salutes the flag, who serves beneath the flag, and whose coffin is draped by the flag, who allows the protester to burn the flag.”

In closing, I want to thank all of you for the honor and privilege it has been to serve as your Academy president. I believe we have made tremendous strides during the past year in advocating on behalf of our patients and our profession, and we will see the results of our labors in the coming years. My best wishes to my successor Joseph D. Zuckerman, MD, and my heartfelt thanks to the members of the Board of Directors, the Board of Councilors, Board of Specialty Societies, Councils, Cabinet, Committees, Sub-committees, the hundreds of volunteers, and all of the AAOS staff who make this such a great organization.

AAOS Now
February 2009 Issue
http://www.aaos.org/news/aaosnow/feb09/youraaos2.asp