AAOS, OTA host war injuries symposium
By Andrew N. Pollak, MD and Jason Calhoun, MD
“Extremity War Injuries: Current, State-of-the-Art and Future Directions,” an educational session summarizing the results of a recent conference cosponsored by the AAOS and the Orthopaedic Trauma Association (OTA), will be held tomorrow morning at 8:00 a.m. in Room S406 at McCormick Place. AAOS members interested in this important topic are urged to attend this free symposium.
The symposium is based on the “Extremity War Injuries: State of the Art and Future Directions” (EWI) research symposium recently held in Washington, D.C. The session will be moderated by Andrew N. Pollak, MD, who was a co-organizer for the original meeting.
The genesis of EWI
The EWI research symposium resulted from a discussion between Lt.Col. Daniel White, MD, MC, and then-incoming AAOS President Stuart L. Weinstein, MD, during the 2005 Annual Meeting. During a tour of the Walter Reed Army Medical Center (WRAMC), Drs. White and Weinstein wondered whether the AAOS could assist in the identification and development of future research directions on combat injuries. Extremity injuries are among the most common injuries seen in modern warfare.
“It is imperative we provide the best possible orthopaedic care for our injured soldiers,” said Dr. Weinstein. “These injuries affect our soldiers every day; and we need to assist in moving potential orthopaedic research along to benefit them as soon as possible.”
The EWI meeting addressed broad areas of common combat-related clinical problems. Sessions featured panels of military and civilian experts and included international expertise from Iraq, Israel, Canada, United Kingdom and Serbia and Montenegro. We were honored to be asked to host the symposium.
The EWI Symposium in Washington, DC, covered a number of topics, including:
• Amputee Care: Limb loss is a common combat-related injury. Today, more amputees than ever before are able to live fully active, functional lives. The future of prosthetic development and restoration of limb function is key to amputee care.
• Antibiotics and Infection: Because of the complexity of injuries incurred during battle, infections are common. Preventing orthopaedic infection has been a high priority in the planning and execution of the medical care provided to combat casualties in Iraq and Afghanistan. Treating the complex infections that affect combatants creates new challenges that demand innovative solutions.
• Segmental Bone Defects: The skeleton has an intrinsic capacity to repair itself, which is best observed in the healing of fractured bones. However, when bone defects occur as a result of severe injury, healing may not result spontaneously. Exploring the scope of injuries and reconstructive challenges, as well as advancements in technology to help fracture healing, is central to achieving the best possible outcomes for our soldiers.
• Stabilization of Long Bones: Injuries resulting from explosives and high-impact gunshot wounds commonly involve unstable open fractures. Reviewing the scope of wounds, stabilization and treatment options will help to understand how to manage these types of injuries.
• Wound Management: Combat casualty care is a dynamic process that continues to evolve. Understanding the types of injuries incurred, frequency, timing of treatment and location of care are important to managing combat-related wounds. It is essential to examine the safe “window” for treating specific extremity war injuries — particularly if it is unsafe to move a patient for a period of time or if an operating room is distant to the site of injury — to determine the best course of action.
Goals and activities
The EWI Symposium’s direct goals were to prioritize future military orthopaedic trauma research topics and determine the next steps to understand more about extremity war injuries. Therefore, several legislators were invited to address the audience.
Sen. Conrad Burns (R-Mont.), a member of the U.S. Senate Appropriations Subcommittee on Defense, and Sen. Ted Stevens (R-Alaska), chairman of the U.S. Senate Appropriations Defense Subcommittee, attended the opening reception. Both are strongly committed to funding this arena and promised their future support.
The symposium also featured a site visit to WRAMC, hosted byCol. William C. Doukas, MD, MC, and several staff members. Participants were able to interact with key WRAMC rehabilitation staff and patients to see how research advances have benefited the patient population.
Many of the extremity injuries from Operation Iraqi Freedom and Operation Enduring Freedom have been devastating. WRAMC patients, however, particularly those in the amputee care program, have seen extraordinary advances. Several of the patients run marathons, snowboard and ski. Medical advances have directly helped these patients achieve as normal a lifestyle as possible despite the loss of their limb/s.
The passage of the FY2006 Defense Appropriations bill — which included approximately $7.5 million to develop the Orthopaedic Extremity Trauma Research Program at the U.S. Army Institute of Surgical Research (ISR) in Ft. Sam Houston, Tex. — makes determining orthopaedic research priorities a critical next step. The Washington, D.C., office is currently working with key contacts on Capitol Hill to secure funding for this program in the FY 2007 appropriations cycle.
The AAOS and the OTA have established several “next steps.” Symposium proceedings and a list of future research directions will be published in a fall supplement to the Journal of the American Academy of Orthopaedic Surgeons (JAAOS). The future research directions identified at the symposium will be distributed on Capitol Hill, in coordination with the AAOS Washington, D.C., office.
Tomorrow’s symposium is another outgrowth of the EWI conference. The symposium will be moderated by Dr. Pollak. Speakers will include Dr. Calhoun, Chairman, distinguished professor, University of Missouri, Columbia; Col. Mark R. Bagg, MD, chief of the department of orthopaedics and rehabilitation at Brooke Army Medical Center; Michael J. Bosse, MD, president-elect of the OTA; Col. William C. Doukas, MD, MC, chairman, department of orthopaedics and rehabilitation at WRAMC; and Lt. Cmdr. Michael Mazurek, MD, director, orthopaedic trauma, department of orthopaedic surgery at Naval Medical Center, San Diego, and specialty assistant for orthopaedic trauma to the Navy Surgeon General.