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EWI-IV highlights advances in combat care

By Lindsay Law and Mary Ann Porucznik

Wounded warrior recounts road to recovery

“I would not be here today, if not for the professionalism of those surgeons deployed in the war zone,” admitted CPT Raymond O’Donnell, the first patient to participate in the Extremity War Injuries (EWI) symposia sponsored by the AAOS, the Orthopaedic Trauma Association, and the Society of Military Orthopaedic Surgeons. Capt. O’Donnell was among the featured speakers at EWI-IV: Collaborative Efforts in Research, Host Nation Care, and Disaster Preparedness, Jan. 21–23, in Washington, D.C.

CPT Raymond O’Donnell Courtesy of Robert L. Knudsen Photography, Inc

A recipient of a Bronze Star Medal with Oak Leaf Cluster, Capt. O’Donnell was injured during a routine combat patrol in August 2007 in Afghanistan. “My vehicle was split in half. I was ejected and two of my fellow soldiers died. As a result of the accident, I sustained several severe injuries, including a left hip dislocation that also fractured my pelvis and hip joint, a fracture and dislocation of my right wrist, a bladder rupture, several facial bone fractures, and a collapsed lung,” he said.

Capt. O’Donnell also sustained a severe concussion that required extensive treatment for traumatic brain injury when he returned to the United States. With intensive treatment, he has fully recovered from the traumatic brain injury, but his musculoskeletal injuries continue to present problems. “I no longer have full range of motion in my right wrist or in my hips, or the use of my left leg below the knee,” he said.

The use of a special brace enables Capt. O’Donnell to walk independently, but his activities are still limited and he is in chronic pain from his injuries.

“The challenges that my fellow Warriors and I face after our injuries are the reason we need programs like the Extremity War Injury Symposium and the Orthopaedic Extremity Trauma Research Program,” he continued.

Injuries require new approaches
Since the beginning of Operations Iraqi Freedom and Enduring Freedom, as many as 82 percent of the nearly 31,000 battle casualties involve extremity injuries. Accord­ing to COL James R. Ficke, MD, co-chair for EWI-IV, “Advances in combat casualty care have enabled us to save the lives of many who return from the battlefield with a wide range of life-long disabilities. But many cannot achieve the goal of a full recovery due to the musculoskeletal injuries they sustained, and the nerve injuries associated with that trauma.

“The musculoskeletal injuries sustained by combat troops require us to re-evaluate the way that clinicians and scientists approach these problems,” explained Col. Ficke. “Previous conflicts have provided vast expertise in the areas of resuscitation, débridement, initial stabilization, and even definitive fixation, but surgeons and soldiers still face large barriers to unimpeded recovery.

“These Warriors’ losses must not be in vain,” he continued. “We simply must capture our lessons, and scientifically examine these injuries to continuously improve their treatment.”

(From left) Andrew N. Pollak, MD (EWI-IV cochair); Rep. John Murtha; COL James R. Ficke, MD (EWI-IV cochair); and David W. Polly, Jr., MD, at the EWI-IV symposium. Courtesy of Robert L. Knudsen Photography, Inc

Application in civilian sector
“Open extremity injuries are a major cause of disability in the civilian and military population,” noted Andrew N. Pollak, MD, who co-chaired the symposium with Col. Ficke. “An estimated 250,000 open fractures occur each year in the U.S. civilian population alone.”

The EWI symposia bring together the nation’s top orthopaedic and trauma surgeons and researchers to discuss advances in the care and treatment of those who sustain musculoskeletal injuries. Now in its fourth year, the EWI Symposia series has featured research findings in the areas of bone regeneration, soft-tissue healing, prevention of wound infection, improving irrigation/débridement techniques, prevention of heterotopic ossification, and translating research into practice.

The symposia have also resulted in a request to Congress for additional federal funding for EWI research through the U.S. Depart­ment of Defense to offer wounded soldiers better healing outcomes and daily living capabilities.

“The peer-reviewed Orthopaedic Extremity Trauma Research Program (OETRP) is our effort to improve treatment and outcomes of battlefield extremity injuries,” said Dr. Pollak.

$150 million in research funding?
OETRP is part of the Medical Research and Materiel Command medical research program and is administered by the U.S. Army Institute of Surgical Research in Fort Sam Houston, Texas. To date, 162 proposals have been accepted, and 26 have been funded for a total of $19.3 million.

Two members of the House Appropriations Committee—Rep. C.A. “Dutch” Ruppersberger of Maryland and Rep. John Murtha of Pennsylvania, who chairs the committee’s subcommittee on Defense—also attended the symposium and expressed their support for ongoing research in this area.

In his keynote address, Rep. Murtha discussed his commitment to funding research to improve care for wounded warriors. He also expressed a willingness to fund orthopaedic research at an annual level of $150 million if researchers and organizers could demonstrate that such funds would be used directly for important research to limit disability from a wide variety of conditions, including posttraumatic arthritis.

Rep. C.A. “Dutch” Ruppersberger addressed the EWI-IV symposium. Courtesy of Robert L. Knudsen Photography, Inc

Bringing the message home
A key feature of EWI-IV was its emphasis on disaster preparedness. According to Christopher T. Born, MD, director of orthopaedic trauma at Rhode Island Hospital, “Many factors make the United States increasingly vulnerable to mass casualties events, including increasing population density, environmental degradation, advancing technology, the increased presence of hazardous materials and infectious disease strains, and the very real threat of terrorist acts.

“Orthopaedic surgeons and trauma centers possess unique skill sets and are well positioned to assist in the management of injuries following a mass casualty event,” he continued. “With foresight and a degree of preparation and planning, the consequences of both natural and man-made disasters can be significantly reduced.” (For more on what orthopaedic surgeons can do, see “What will you do when disaster strikes?”)

AAOS Now
March 2009 Issue
http://www.aaos.org/news/aaosnow/mar09/cover2.asp