Maj. Anita McSwain, MD, 506th Expeditionary Medical Squadron, reaches for her “tools of the trade” during surgery.
Courtesy of DVIDS


Published 11/1/2008
Lindsay Law

Orthopaedic trauma research receives $66 million

AAOS efforts result in major victory

It’s nowhere near the $700 billion bailout for Wall Street, but the $66 million in support of peer-reviewed orthopaedic trauma research in the 2009 fiscal year (FY) budget represents the single largest increase in the annual federal investment in musculoskeletal research. The money will go a long way to improving care for patients and supporting the careers of clinician-scientists, and it marks a major victory for orthopaedics—due in great measure to coordinated efforts by the AAOS, the Orthopaedic Trauma Association (OTA), and the Society of Military Orthopaedic Surgeons (SOMOS).

The funding was included in the “Consolidated Security, Disaster Assistance, and Continuing Appropriations Act” (HR 2638), signed by President George W. Bush on Sept. 30, 2008. The measure includes the FY 2009 appropriations bills for Defense, Homeland Security, and Military Construction-Veterans’ Administration and funds most remaining federal programs at FY 2008 levels through March 6, 2009.

A major success
The funding is a major success for orthopaedic trauma research and a direct result of the AAOS’s vision and lobbying efforts, according to Andrew N. Pollak, MD, chair of the extremity war injuries and disaster preparedness project team. Members of the AAOS and OTA aggressively advocated for this much-needed funding by testifying before congressional committees, making personal visits to congressional representatives, and sending letters to key members of Congress and their staffs.

The message they delivered underscored the profound need for focused medical research to help military surgeons find new limb-sparing techniques with the goal of avoiding amputations and preserving and restoring the function of injured extremities. As a result, during the past 2 years, $101 million in additional funding has been earmarked for orthopaedic trauma research.

“Over the next few months, we will continue to work with the Army to make sure these funds are used to stimulate the best possible research and to foster an environment that both improves clinical care for our injured warriors and supports and stimulates the careers of orthopaedic clinician-scientists,” said Dr. Pollak.

“We will continue to advocate for additional funding for orthopaedic trauma research. Our goals are to increase funding for this program to match the levels of funding for breast and prostate cancer research in the Department of Defense and to ensure that these programs are funded at appropriate levels in perpetuity,” he said.

Why funding is essential
At no time in history has the need for orthopaedic trauma research been more pressing. The likelihood that a soldier wounded on the battlefield would survive was 69.7 percent in World War II and 76.4 percent in Vietnam. Today, thanks in part to the use of body armor, “up-armored” vehicles, intense training of combat personnel, and surgical capability within minutes of the battlefield, 90.2 percent of wounded soldiers will survive their injuries.

In addition, military researchers have documented that approximately 82 percent of warriors injured in battle during the global war on terror sustain extremity injuries. Improvements in protective body armor have reduced the number of life-threatening injuries to the torso, but improvised explosive devices inflict multiple severe injuries to the extremities.

Rapid delivery of prehospital care on the battlefield and resuscitative surgical care in military medical treatment facilities have markedly improved survival from severe combat injuries. The result is a new type of patient, a surviving warrior with severely mangled extremities. Such injuries are rarely seen in civilian surgical hospitals, even in Level 1 trauma centers.

Compounding the difficulty in treating these battlefield injuries is the threat of serious infections due to the nature of the injuries and the environment where they are sustained and the need for long-distance transport for more complex surgery.

EWI symposia examine research and advances
The Academy’s interest in this effort began early in the global war on terror. Deployed military orthopaedic surgeons began to report on their need for clinical and research support in extremity trauma treatment. Studies on the nature of injuries in Iraq and Afghanistan quickly documented both the severity and the high proportion of extremity injuries.

As a result, the AAOS and the OTA sponsored the first Extremity War Injuries (EWI) Research Symposium in January 2006. The initiative was designed to examine the nature of extremity injuries sustained during Operation Enduring Freedom and Operation Iraqi Freedom and to plan for advancing the state of the science and treatment of these injuries by developing a consensus prioritized list of research objectives. Results of the symposium were published in a special supplement to the Journal of the AAOS (JAAOS) in October 2006 and are available online at

The second symposium, in 2007, focused on the development of treatment principles for far-forward surgical care. In 2008, the EWI III symposium, sponsored by the AAOS, SOMOS, and OTA, was attended by more than 125 military and civilian leaders in extremity trauma research and treatment from around the world. This symposium resulted in definition of consensus principles for treatment at definitive care facilities for select conditions associated with combat injuries. Summaries of both the EWI II and EWI III symposia also appeared in JAAOS and are available online.

“I am constantly amazed at the dedication of our military surgeons,” said Col. James R. Ficke, MD, current chairman of orthopaedics and rehabilitation at Brooke Army Medical Center, the orthopaedic surgery consultant to the U.S. Army Surgeon General, and co-chair of the EWI Symposium. “Military surgeons and patients are pushing the envelope on the treatment, research, and knowledge of blast injuries every day.

“Our research findings in extremity injuries and infection, reconstruction, amputation and rehabilitation have and will continue to dramatically improve our treatment of trauma patients in the civilian population as well as on the battlefield.”

The fourth annual AAOS/OTA/SOMOS EWI research symposium will be held in Washington, D.C., on Jan. 22–23, 2009, and will focus on collaborative efforts in research, host nation care, and disaster preparedness. Both AAOS Now and JAAOS will have coverage of the event.

Lindsay Law is communications manager in the AAOS office of government relations. She can be reached at

Additional Links:

JAAOS Special Supplement: EWI-I

JAAOS summary: EWI-II

JAAOS summary: EWI-III

“Beyond the Battlefield: EWI-I”

“Orthopaedic surgeons wage war against extremity injuries: EWI II”

“Symposium fuels support for research: EWI III”

EWI-I: State of the Art and Future Directions

EWI-II: Development of Clinical Treatment Principles

EWI-III: Challenges in Definitive Reconstruction

EWI-IV: Extremity War Injuries

Extremity War Injuries and Disaster Preparedness