Andrew N. Pollak, MD helped make the case for increasing funding for the Orthopaedic Extremity Trauma Research Program to $50 million in 2008.

In his testimony, Dr. Pollak discussed the spectrum of orthopaedic trauma sustained by U.S. military personnel in Iraq and Afghanistan and updated committee members on the progress of the peer-reviewed Orthopaedic Extremity Trauma Research Program (OETRP), which is administered by the U.S. Army Institute of Surgical Research.

“Unique to this conflict is a new type of patient,” said Dr. Pollak, “a warfighter with multiple and severely mangled extremities who is otherwise free of life-threatening injury to the torso because of improvements in protective body armor.”

Dr. Pollak pointed out that the vast majority of trauma experience in Iraq and Afghanistan is orthopaedic-related, noting that of 1,566 soldiers injured from October 2001 through January 2005, 82 percent had extremity injuries. Improvised explosive devices (IEDs), rocket-propelled grenades (RPGs), and high-velocity gunfire create open, complex wounds with severe bone fragmentation, as well as damage to nerves, tendons, muscles, vessels, and soft tissue.

Military orthopaedic surgeons are actively involved in evaluating and scoring proposals under OETRP; proposals are scored based on military relevance, military impact, and scientific merit. “This unique process ensures that research projects selected for funding have the highest chance for improving treatment of battlefield injuries,” said Dr. Pollak.

“There is a profound need for targeted medical research to help military surgeons find new limb-sparing techniques to save injured extremities, avoid amputations, and preserve and restore the function of injured extremities,” he continued.

In reviewing the first year of the program, Dr. Pollak noted that close to 100 preproposals were received, 76 were invited to compete, 60 were evaluated, but only 14 could be funded for their first year of research, based on available funding—$7.5 million. Additional funding of $6.8 million allocated in fiscal year 2007 will do little more than continue current projects, with a few new starts.

An allocation of $50 million in supplemental appropriations would not only cover the backlog of unfunded research capacity, it would, said Dr. Pollak “benefit our men and women serving in the Global War on Terror and in future conflicts.”

Military help for civilian injuries
On Memorial Day 2006, a car bomb critically injured Dozier and killed four others—an Army captain, a cameraman, a soundman, and their Iraqi translator. The bombing pulverized her thighs, nicked her femoral artery, and launched a piece of shrapnel into her brain. She received initial treatment at a field hospital in Iraq, was flown to a U.S. military hospital in Germany, and finally transferred to Bethesda Naval Hospital.

“I know from painful, personal experience that an instant of injury will lead to a months-long, nightmarish journey. That is, if the victims are lucky—if they have the care of the U.S. military,” wrote Dozier in January 2007. “The U.S. military treated me as one of its own, saving my life a few times over, with the best people, the best training, and the best equipment. But the system is running at full capacity, and many of the doctors, nurses, and corpsmen I met are battling exhaustion, burnout, and just plain heartache to keep going.”

She paid tribute to those who treated her, saying, “Those men and women worked the same kind of miracles on me that they do daily for thousands of injured servicemen: they repaired two shrapnel-shattered legs; moved skin around my body like a jigsaw puzzle to cover burns the bomb left behind; and taught me to walk again, all the while, propping up my spirits in between.”

After the hearing, Dozier, Dr. Pollak, and David W. Polly, MD, former chair of the department of orthopaedic surgery and rehabilitation at Walter Reed Army Medical Center, met privately with the subcommittee’s chair and vice chair—Senators Daniel K. Inouye (D-Hawaii) and Ted Stevens (R-Ark.)—to continue the discussion on the importance of increased funding for this issue.

For more information on extremity war injuries, visit www.aaos.org/warinjuries