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Extremity War Injuries: Development of Clinical Treatment Principles

Ficke, James R. MD, MC, USA; Pollak, Andrew N. MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: October 2007 - Volume 15 - Issue 10 - p 590–595

The AAOS/OTA Extremity War Injuries: Development of Clinical Treatment Principles symposium, held in January 2007, was a follow-up to the first Extremity War Injuries symposium held a year earlier. Discussion focused on four specific areas: prehospital management of extremity wounds, initial débridement, early stabilization, and postoperative wound management during air evacuation. Liberal emergency use of field tourniquets likely is contributing to lower overall mortality and is associated with very low rates of complications. Additional tools for extremity hemorrhage control, such as chitosan-based patches and granular zeolite hemostat, were postulated to be effective. Consensus opinion was that necrotic, devitalized, and contaminated tissue must be removed although objective assessment of completeness of initial débridement is difficult. Definitive open reduction and internal fixation for US and Coalition forces in the theater of operations should be limited to fracture patterns associated with significant perceived risk of delay in treatment. Finally, primary skin closure should be avoided in theater. In addition, because of the time and complications involved in transporting patients to level 4 care facilities, surgeons should consider release of compartments prior to patient transport whenever significant perceived potential for compartment syndrome is present.

Dr. Ficke is Orthopaedic Consultant to the U.S. Army Surgeon General and Chairman, Department of Orthopaedics and Rehabilitation, Brooke Army Medical Center, Fort Sam Houston, TX. Dr. Pollak is Associate Professor of Orthopaedics and Head, Division of Orthopaedic Traumatology, University of Maryland School of Medicine, and Attending Orthopaedic Traumatologist, R Adams Cowley Shock Trauma Center, Baltimore, MD.

Neither Dr. Ficke nor a member of his immediate family has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article. Dr. Pollak or a member of his immediate family has received research or institutional support from Synthes, Stryker, and Smith & Nephew, and serves as a consultant to or is an employee of KCI.

The opinions or assertions expressed herein are those of the authors, and do not reflect those of the Army, Navy, Air Force or of the Department of Defense.

Reprint requests: Dr. Pollak, University of Maryland School of Medicine, Suite T3R54, 22 South Greene Street, Baltimore, MD 21201.

© 2007 by American Academy of Orthopaedic Surgeons
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