“Injury patterns sustained by deployed soldiers have been understudied,” explained Lt. Col. (P) Philip J. Belmont Jr., MD, “particularly when considering the types of injuries and how they are addressed later. Our previous studies have focused on combat and noncombat injuries sustained in-theater. This study focuses on soldiers who have completed their combat tours and returned home.”

Dr. Belmont is the lead author of “Non-Emergent Orthopaedic Injuries Sustained by Soldiers in Operation Iraqi Freedom,” which was published earlier this year in The Journal of Bone & Joint Surgery–American. The prospective, longitudinal cohort study focuses on 4,122 soldiers (3,797 male; 325 female) from a single brigade combat team stationed in Iraq. The average age of the cohort at deployment was 23 years (range:18 to 52 years).

“We found that 3,787 of the service members returned after their 15-month term. Many of them had sustained some injury and all had access to first-line care while some had evaluations by orthopaedic surgeons during their deployments,” said Dr. Belmont. “In addition, 35 soldiers died during deployment and another 300 were medically evacuated from the combat zone.”

Dedication despite injury
Upon their return to the United States, 731 soldiers received orthopaedic consultations, including 79 who had combat injuries. An explosive mechanism (improvised explosive device, mortar, or rocket-propelled grenade) was the cause of injuries in 46 of the 79 patients.

In addition, 4 percent of all returning soldiers required orthopaedic surgery, with 140 operations performed. Age of 30 years or older was an important risk factor for orthopaedic consultation. The most common surgical procedures performed were for shoulder stabilization, superior labrum anterior to posterior (SLAP) lesion repair, treatment of internal derangement of the knee, and treatment of foot deformity.

“In my opinion, this study has two important takeaway points,” said Dr. Belmont. “First, many soldiers will need quality orthopaedic care after their deployment for orthopaedic injuries or conditions that have been aggravaed or exacerbated.

“Second, many service members completed their deployment even though they had sustained an injury. We found that 84 percent of the soldiers with shoulder instability were able to return to duty within 72 hours of injury, and 55 percent of those soldiers with anterior cruciate ligament disruptions were able to keep serving in Iraq.

“That’s an impressive statistic,” Dr. Belmont continued. “These people volunteered to serve their country, and they maintained that dedication despite their orthopaedic injuries.”

More info needed
Dr. Belmont noted that the study data could affect public policy. Only about half of all soldiers are active duty military; the rest are members of the National Guard and reserves. As a result, returning soldiers who have chronic injuries may increase the burden on the civilian medical system.

“The National Guard and the reservists are an important part of our national defense. When they come home they may decide to access care through the Veterans Health Administration or the civilian community,” said Dr. Belmont.

“Injured soldiers who are treated by the military initially will often receive follow-up care from civilian orthopaedists,” he added. “In that respect, it’s a team effort.”

Dr. Belmont and his colleagues plan to continue following the cohort on a longer term basis.

“What are the long-term outcomes?” he asked. “How many of these service members will return to active duty? Is there a difference in treatments between the combat and noncombat injuries? What kind of effect will psychiatric conditions and posttraumatic stress disorder have on their ultimate outcomes? These questions still need to be answered.”

Dr. Belmont’s coauthors include Brett D. Owens, MD, Gens P. Goodman, DO, Andrew J. Schoenfeld, MD, Jason R. Dutton, DO, and Robert Burks, PhD.

Disclosure information: Dr. Bel-mont—SLACK Incorporated; Dr. Owens,—Musculoskeletal Transplant Foundation, American Journal of Sports Medicine, Journal of Surgical Orthopaedic Advances, Orthopedics, Orthopedics Today; Drs. Goodman, Schoenfeld, and Dutton—no conflicts; Dr. Burks—no information available.

Peter Pollack is a staff writer for AAOS Now. He can be reached at ppollack@aaos.org

Bottom Line

• Nearly 20 percent of returning soldiers required consultation for orthopaedic injuries, and 4 percent required surgery.
• Many service members complete their deployments despite sustaining a significant orthopaedic injury.
• Returning soldiers may increase the burden on the civilian medical system, creating a health policy issue.