October 2000 Bulletin

Orthopaedists keep forces fit to fight

Peacetime duty focuses on injury prevention, practicing for support of deployed troops

By Capt. Thomas R. Cullison, MD

Why would an orthopaedic surgeon become involved in research on body armor? In the military setting this is preventive medicine. For the past two years CDR Marlene Demaio, MC, USN has been developing materials to decrease severe combat injuries at the Armed Forces Institute of Pathology on the Walter Reed Army Medical Center complex in Washington, D.C.

Orthopaedic surgeons serving on active duty in our armed forces practice in settings both familiar and exotic compared to our civilian counterparts. Our overarching goal is force protection: ensuring that soldiers, sailors, airmen and marines are healthy and fit to fight. To do this, we maintain an active peacetime practice focused upon injury prevention and care while simultaneously practicing for care in a field environment in direct support of deployed troops.

Much of a military practice would be very familiar to any practicing orthopaedist. Most of our time is spent in a hospital-based community practice, very similar to that of a salaried civilian HMO physician. As the majority of our patients are young and healthy, the focus tends to be on sports injuries, pediatrics and trauma. Our population is aging, however. Today, 50 percent of military beneficiaries are retired. In 2005, the number of military retirees over 65 will outnumber those on active duty.

Military occupation and lifestyle also lends itself to conditions rarely seen in large numbers in the civilian community. Static line parachuting has produced information on biceps tendon rupture based on experience at Womack Army Medical Center caring for Army airborne soldiers. Basic training of all services has lead to an unequaled body of literature on stress injuries. Recently, the focus has been upon stress fractures in female recruits, an area unstudied until the last decade. Preventive measures including footwear and training patterns are applicable to any practice.

Military orthopaedic surgeons are comfortable in a field environment as well. During the last 10 years we have deployed to the Persian Gulf, Somalia, Haiti, Panama, Sri Lanka, the former Yugoslavia and other areas.

Care is delivered in operating rooms aboard ship, in tents and in foreign hospitals. Navy/Marine amphibious groups include ships with four-six surgical suites comparable to those in stateside hospitals. Army and Navy deployable hospitals provide up to 1,000 beds, surgical suites for all specialties, blood bank facilities and the ability to provide routine as well as trauma care. Air Force medical evacuation units and aircraft allow rapid transportation and in-flight treatment, if required.

Rarely does one service operate independently today. A typical example involved several Army personnel injured by a land mine in Somalia. A Marine helicopter flew them to a ship where initial debridement and fixation was performed by a Navy surgeon. The next morning an Air Force medevac plane transported them to an Army hospital in Europe.

Treatment of open fractures has been guided by experience in military conflicts throughout time. Experience in the Vietnam conflict resulted in routine stabilization, debridement and prophylactic antibiotics. Subsequent ballistics studies demonstrated soft tissue damage caused by high velocity munitions, leading to more aggressive debridement and second-look surgery. These hard-earned lessons have become the basis of today’s trauma care.

TriService cooperation is facilitated through the Society of Military Orthopaedic Surgeons (SOMOS), the military equivalent of a state society. The annual meeting is a forum for research papers from the 10 military orthopaedic surgery residencies and two fellowships, as well as that of practicing active and reserve medical corps officers.

Over the years, significant contributions have included hip dysplasia screening examination in the nursery, acute shoulder dislocation rehabilitation and anterior cruciate ligament surgery, to name but a few. Orthopaedic surgeons from all three services recently formed the Military Sports Medicine Consortium creating a large patient population for outcome studies following knee and shoulder surgery.

Further information regarding military orthopaedic surgery may be found on the web at www.somos.org or by email at TCullison@nhlej.med.navy.mil.

(Capt. Cullison is Commanding Officer, Naval Hospital, Camp Lejeune, N.C.)

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