During the course of the Iraq and Afghanistan Wars, military orthopedic surgeons have made significant technical and philosophic changes in the treatment of musculoskeletal combat casualties. The widespread use of individual and vehicular body armor, evolution of enemy tactics to include its reliance on improvised explosive devices, and the effectiveness of treatment rendered at military treatment facilities have resulted in a large burden of complex orthopedic injuries. Combat Orthopedic Surgery: Lessons Learned in Iraq and Afghanistan represents and recognizes the latest advances in musculoskeletal surgical care performed to treat today’s US military servicemembers.
Editors LTC Brett D. Owens, MD and LTC Philip J. Belmont Jr., MD have brought together the leading military orthopedic surgeons to relay their clinical orthopedic surgery expertise, as well as to discuss how to provide optimal care for combat casualties both initially in theater and definitively at tertiary care facilities within the United States.
Combat Orthopedic Surgery: Lessons Learned in Iraq and Afghanistan is divided into five sections, with the first being devoted to an overview of general topics. The second section covers scientific topics and their clinical application to musculoskeletal combat casualties. The final three sections are clinically focused on the upper extremity, lower extremity, and spine and pelvic injuries, with many illustrative case examples referenced throughout.
Most Clinical Chapters Contain:
• Introduction/historical background
• Epidemiology
• Management in theater
• Definitive management
• Surgical techniques
• Outcomes
• Complications
Combat Orthopedic Surgery: Lessons Learned in Iraq and Afghanistan will be the definitive academic record that represents how orthopedic surgeons currently manage and treat musculoskeletal combat casualties.
Dedication |
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Acknowledgments |
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vii | |
About the Editors |
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Contributing Authors |
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xi | |
Preface |
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xv | |
Foreword |
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xvii | |
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Foreword |
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Introduction |
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xxi | |
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1 | (50) |
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Chapter 1 The History of Combat Orthopedic Surgery |
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3 | (10) |
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Chapter 2 The Combat Environment and Epidemiology of Musculoskeletal Combat Casualties |
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13 | (10) |
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LTC Philip J. Belmont Jr. |
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Chapter 3 Echelons of Care |
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23 | (8) |
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Chapter 4 The Forward Surgical Team |
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31 | (8) |
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LTC Philip J. Belmont Jr. |
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Chapter 5 Combat Support Hospitals |
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39 | (6) |
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Chapter 6 Landstuhl Regional Medical Center |
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45 | (6) |
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51 | (84) |
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Chapter 7 Ballistic, Blast, and Burn Injury: Science and Clinical Implications |
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53 | (12) |
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Chapter 8 Management of Complex Combat-Related Soft Tissue Wounds/Negative Pressure Wound Therapy |
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65 | (12) |
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Chapter 9 Basic Science of War Wounds |
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77 | (8) |
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LCDR Jonathan Agner Forsberg |
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Chapter 10 Heterotopic Ossification |
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85 | (8) |
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LCDR Jonathan Agner Forsberg |
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Chapter 11 Irrigation and Debridement |
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93 | (8) |
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Chapter 12 Tissue Engineering and Regeneration |
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101 | (8) |
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Chapter 13 Infection in Orthopedic Extremity Injuries |
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109 | (12) |
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121 | (8) |
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Chapter 15 External Fixation Principles |
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129 | (6) |
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Section III Upper Extremity |
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135 | (56) |
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Chapter 16 Upper Extremity Nerve Injuries |
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137 | (10) |
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Chapter 17 Upper Extremity Amputations |
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147 | (10) |
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Chapter 18 Upper Extremity Coverage: Management of Combat-Related Soft Tissue Injury of the Upper Extremity |
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157 | (12) |
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Chapter 19 Complex Reconstructive Challenges in Hand and Forearm Wounds |
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169 | (12) |
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LTC(P) Martin F. Baechler |
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Col Chester C. Buckenmaier III |
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Chapter 20 Complex Elbow and Shoulder Injuries |
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181 | (10) |
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Section IV Lower Extremity |
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191 | (92) |
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Chapter 21 Lower Extremity Limb Salvage |
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193 | (12) |
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LTC(P) Romney C. Andersen |
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Chapter 22 Combat-Related Lower Extremity Amputations |
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205 | (16) |
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LCDR Jonathan Agner Forsberg |
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Chapter 23 Prostheses for Major Extremity Amputations |
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221 | (16) |
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Chapter 24 Long-Bone Fracture Management |
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237 | (16) |
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Chapter 25 Lower Extremity Coverage: Management of Combat-Related Soft Tissue Injury of the Lower Extremity |
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253 | (16) |
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Chapter 26 Complex Foot and Ankle Injuries |
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269 | (14) |
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283 | (36) |
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Chapter 27 Combat Injuries to the Pelvis and Acetabulum |
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285 | (12) |
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LTC(P) Romney C. Andersen |
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Chapter 28 Spine Fractures |
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297 | (14) |
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Chapter 29 Spine Neurologic Injury |
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311 | (8) |
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Financial Disclosures |
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319 | (2) |
Index |
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321 | |
LTC Brett D. Owens, MD is a Distinguished Graduate of the United States Military Academy in West Point, New York. He graduated from the Georgetown University School of Medicine in Washington, DC and completed his internship at Walter Reed Army Medical Center. He completed his orthopaedic surgery residency at the University of Massachusetts and the John A. Feagin Jr. Sports Medicine Fellowship at West Point. He is currently an Associate Professor of Surgery (Orthopaedics) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. He served as an orthopaedic surgeon with the 86th Combat Support Hospital in Iraq and is currently Chief of Orthopaedic Surgery Service, Keller Army Hospital, West Point, New York.
LTC Philip J. Belmont Jr, MD is a Distinguished Graduate of the United States Military Academy in West Point, New York. He graduated from the Duke University School of Medicine in Durham, North Carolina and completed his internship and orthopaedic surgery residency at Walter Reed Army Medical Center in Washington, DC. He is currently an Associate Professor of Surgery (Orthopaedics) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. He served as an orthopaedic surgeon with the 228th Combat Support Hospital in Iraq and is currently the Chief of Adult Reconstruction and Program Director of the William Beaumont Army Medical Center/Texas Tech University Health Sciences Center Orthopaedic Surgery Residency Program at William Beaumont Army Medical Center, El Paso, Texas.