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In his remarks to the subcommittee, Dr. Pollak emphasized that orthopaedic surgeons need the information generated by the PRORP. Such research, he noted, provides the evidence to support proper treatment of high-energy extremity injuries and outlines the long-term consequences of these injuries, which will remain a challenge to military surgeons for at least the next decade.


Published 8/1/2012
Madeleine Lovette

AAOS Treasurer Testifies on Behalf of Injury Research

Tells Senate committee that failure to fund PRORP would constitute abandoning military

“Dr. Pollak, did I hear you say that 47,000 troops were injured in Iraq and Afghanistan, and of that number, 80 percent had limb injuries?” asked Chairman of the Senate Appropriations Committee, Daniel K. Inouye (D-Hawaii) during a Defense Subcommittee hearing on the fiscal year (FY) 2013 Department of Defense (DOD) budget.

“Yes, sir,” testified Andrew Pollak, MD, treasurer of the American Association of Orthopaedic Surgeons (AAOS), and immediate past president of the Orthopaedic Trauma Association. “They are the most common injuries sustained.”

Dr. Pollak was one of 23 witnesses requesting that funding for various research programs be included in the Senate defense appropriations bill during the hearing, which was held on June 6, 2012. Representing the AAOS, Dr. Pollak was speaking on behalf of the DOD Peer Reviewed Orthopaedic Research Program (PRORP), which is now the principal research vehicle for developing better treatments and outcomes for wounded soldiers with traumatic extremity injuries.

Communicating the need
Advances in body armor and battlefield care are enabling military surgeons to save more lives than ever before. However, the need for mobility leaves soldiers’ limbs exposed to the force of weapons such as improvised explosive devices, which are used by enemy forces in Iraq and Afghanistan. As a result, extremity injuries now comprise the largest share of both combat and noncombat injuries in the military.

AAOS Treasurer Andrew Pollak, MD, testifies during the Defense Subcommittee hearing.

“Orthopaedic surgeons at military facilities throughout the country continue to be terribly taxed with the number of wounded warriors returning from duty,” Dr. Pollak told the subcommittee members. “The Peer Reviewed Orthopaedic Research Program helps military surgeons address the leading burden of injury by finding new limb-sparing techniques to save extremities, avoid amputations, and preserve and restore the function of injured extremities.”

Direct benefits of research
Dr. Pollak also testified that the Major Extremity Trauma Research Consortium (METRC) has been integral in producing the evidence needed to establish treatment guidelines for the optimal care of wounded soldiers. He pointed to advancements in the treatment of heterotopic ossification (HO) that can be directly attributed to extremity war injury research.

HO is a condition in which the bone grows in abnormal locations and can press against nerves and blood vessels, resulting in severe pain, limited motion, problems fitting prosthetic limbs, and skin breakdown. “HO is so prevalent after high-energy trauma that nearly 65 percent of wounded warriors with extremity injuries are afflicted,” Dr. Pollak told the subcommittee.

Now, however, thanks to PRORP and its predecessor, the Orthopaedic Extremity Trauma Research Program, “researchers have shown that a drug that interrupts a signaling-nuclear protein pathway can prevent HO, [and] the potential benefit to our wounded warriors is astronomical,” he said.

Benefits outweigh the cost
Dr. Pollak made it clear that the AAOS is conscious of the current austere budget environment, but he emphasized that the cost of not funding the PRORP will be exponentially higher.

“We are under no illusion that this kind of research is cheap,” he stated. “But an amputation costs three times more than limb salvage in future medical care and significantly more than that after accounting for increased disability payments.” In fact, 65 percent of all combat-related medical care resources go to treating extremity injuries.

Dr. Pollak also noted that the types of injuries sustained by wounded troops are similar to the types of injuries that occur during natural disasters and following vehicle crashes. Thus, knowledge garnered from PRORP can improve the quality of trauma care provided to civilian patients.

Despite the nation’s budgetary constraints, Dr. Pollak maintained that caring for the military should be paramount in determining support for PRORP. “While we need to get our fiscal house in order, it cannot be done on the backs of the men and women in uniform,” he asserted. “If we put them in harm’s way, we have a solemn duty to give them the best possible medical care backed by the best possible science.”

“This subcommittee will take these issues into consideration, I can assure you, as we develop the Fiscal Year 2013 appropriations bill,” declared Chairman Inouye following Dr. Pollak’s testimony.

Madeleine Lovette is the AAOS communications specialist in the office of government relations. She can be reached at lovette@aaos.org