Major General James K. Gilman, MD, Commander, US Army Medical Research and Materiel Command (left), presents an achievement award to AAOS Extremity War Injuries Project Team Chair Andrew N. Pollak, MD.
Courtesy of D.Rolls VI Photo Ft. Detrick


Published 10/1/2010
Jamie A. Gregorian, Esq

Combat Casualty Care Conference highlights advancements in care

Andrew N. Pollak, MD, honored for work in advancing orthopaedic research to treat wounded

Military surgeons from around the world—including many orthopaedic surgeons—gathered in St. Pete Beach, Fla., this past August for the annual Advanced Technology Applications for Combat Casualty Care (ATACCC) conference. Among the conference’s highlights was an address by Brig. Gen. Samir Abdullah Hassan, the Iraqi Surgeon General. A significant part of the program focused on extremity trauma research, a long-standing priority of the AAOS.

The ATACCC is the Department of Defense’s (DoD) premier scientific meeting. It provides a forum for scientists and developers to interact with representatives of the war-fighting community and develop ideas and concepts that can benefit battlefield casualties and improve survival and well-being. Intense discussions, focused meetings, and informative presentations help identify strategies and establish milestones for the DoD’s combat casualty care research programs. Nearly all of DoD’s combat casualty care scientists present their latest research results during ATACCC.

The 2010 meeting, which was cosponsored by the U.S. Army and Navy Combat Casualty Care Research Programs and the Air Force Surgeon General’s Office, focused on battlefield medical care issues that have arisen during combat operations in support of Operation Iraqi Freedom and on the technologies available today and perhaps in the future to meet the increasingly complex medical needs of combat casualties.

Extremity trauma research
Although the conference agenda covered multiple disciplines within combat casualty care, orthopaedics played a prominent role. One of the didactic breakout sessions was dedicated to extremity trauma research. The Academy has invested significant educational resources in extremity trauma research through its Extremity War Injuries project team and annual Extremity War Injuries symposium.

Col. Todd Rasmussen, MD, kicked off the session with his presentation on “Vascular Injury Rates in the Wars in Iraq and Afghanistan.” According to Col. Rasmussen, wartime vascular injury rates have increased from barely 2 percent in Vietnam to the current high of 13 percent in Operation Iraqi Freedom. Most vascular trauma is sustained in the extremities, particularly below the elbow and the knee.

Earlier in the day, during a conference-wide presentation titled “Complications and Soft Tissue Injury Contribute to Late Amputation,” Capt. Jeannie Huh, MD, examined the increased prevalence of late amputations among those injured in Iraq and Afghanistan, and the subsequent complications and costs. Dr. Huh defined late amputations as those that occur more than 12 weeks after the injury.

Although only 3.9 percent of civilian amputations and 5 percent of the initial amputations in Operations Enduring Freedom and Iraqi Freedom meet this definition, combat-related late amputations have jumped to 15.2 percent in recent years. According to Dr. Huh’s study, late amputations lead to longer hospital stays, more surgeries, and higher costs. Moreover, late amputations have a higher complication rate than early amputations or limb salvage procedures.

Lobbying for funding
The American Association of Orthopaedic Surgeons (AAOS) has supported limb salvage efforts through lobbying activities to increase funding for the Orthopaedic Extremity Trauma Research and the Peer-Reviewed Orthopaedic Research Programs. These endeavors have led to millions of dollars in federal grants for peer-reviewed orthopaedic research, largely geared toward limb salvage.

During the ATACCC conference, the DoD honored four surgeons, including AAOS Extremity War Injuries Project Team Chair Andrew N. Pollak, MD, for their contributions to the advancement of wounded warrior care.

Dr. Pollak was honored for his “accomplished mentorship, collaborations, and funding opportunities to the Extremity Trauma Research Program” and the “resultant invaluable partnership between the civilian and military orthopaedic research communities.” It also stated that Dr. Pollak’s “expertise and dedication have directly contributed to significant advances in improved care for our nation’s wounded soldiers, sailors, airmen, and marines.”

In accepting the award, Dr. Pollak was quick to credit the AAOS for its dedication to funding efforts aimed at increasing the federal investment in extremity war injury research.

“This award represents important recognition of all of the AAOS efforts to improve care for our wounded warriors,” he said. “Since 2006, the AAOS has invested almost $1.5 million in an effort to educate Congress about the burden of musculoskeletal injury and disease facing and threatening our military. As a direct result of that effort, Congress has appropriated almost $190 million for the Peer-Reviewed Orthopaedic Research Program and the Orthopaedic Extremity Trauma Research Program. This represents the greatest increases ever in the federal investment in musculoskeletal research.”

The defense orthopaedic community will next meet during the AAOS’ Extremity War Injuries symposium. The sixth installment of this annual symposium will take place Jan. 19–21, 2011, at the Mandarin Oriental Hotel in Washington, D.C.

Jamie A. Gregorian, Esq. is the manager of research advocacy for AAOS. To learn more about AAOS’ research advocacy or about the upcoming Extremity War Injuries symposium, e-mail him at