Anterior cruciate ligament (ACL) injuries occur repeatedly in Special Operations Forces (SOF). In this study, we sought to determine whether military patients requiring a second (i.e., revision) ACL reconstruction in the same knee had a lower rate of return to full duty and greater chance of medical discharge versus those undergoing first-time (i.e., primary) ACL knee surgery. A sin-gle-institution, retrospective analysis of surgical records and medical board data of active duty members during a 4-year period identified 19 revision and 169 primary ACL cases, respectively. Measured end points were rate of return to full duty in each group and odds ratio (with 95% confidence interval) for medical discharge. Our results showed that 17 (90%) of 19 revision ACL patients returned to full duty at a mean of 7.5 ± 2.3 months. Two patients did not return to full duty and were medically discharged at 12 and 13 months, respectively. Meanwhile, 155 (92%) of 169 primary ACL patients returned to full duty (mean 7.3 ± 2.3 months), and 14 patients were medically discharged (mean 8.5 ± 2.8 months). Patients in the revision group were only 1.30 times (odds ratio) (95% confidence interval, 0.2726-6.2229) more likely to be medically discharged than patients in the primary group. Overall, the majority of revision ACL surgeries were successful. The period of limited duty was slightly longer after revision ACL surgery. Return to full duty was seen at a similar rate as primary ACL surgery, and the odds of medical discharge were statistically similar. The results are useful in counseling SOF members who might need to undergo revision ACL surgery.
PMID: 23526315 PubMed Citation
DOI: 10.55460/WB7Y-PJOF Digital Object Identifier
Introduction: Military servicemembers in combat operations often sustain injuries to the extremities from highspeed projectiles, resulting in bleeding and comminuted open fractures. Severe injury with bone fragmentation can result in limb amputation. Surgical treatment options include materials that promote osteogenesis and bone proliferation, such as growth hormones, stem cells, or mineralized matrix adjuncts. However, none of these are amenable to use by the first responder, nor do they address the question of hemorrhage control, which is a common problem in traumatic injuries. Hypothesis: Our hypothesis was that treatment with a fibrinogen-based protein mixture at the time of the bone injury will provide both hemostasis and a supportive environment for preservation of injured bone. Methods: A comminuted femur fracture was produced in 28 female Yorkshire swine, and one of four treatments was instilled into the wound immediately after injury. Each animal was evaluated for the following parameters: inflammation, new bone growth, osteoclast proliferation, callus formation, and femur wound cavity fill, using post-mortem computed tomography and analysis of histological sections. Results: Overall, salmon fibrinogen-thrombin and porcine fibrinogen-thrombin showed a trend for improved healing based on bone filling and calcification. However, statistically significant differences could not be established between treatment groups. Conclusions: These findings indicate that a fibrinogen-thrombin matrix may be a useful as an immediate response product to enhance fracture healing. Salmon fibrinogen-thrombin has the advantages of cost and a pathogen profile compared to mammalian fibrinogens.
PMID: 23526316 PubMed Citation
DOI: 10.55460/4SOQ-E5DJ Digital Object Identifier
Success in Special Operations Forces medicine (SOFMED) is dependent on maximizing visual capability without compromising the provider or casualty position when under fire. There is no single ideal light source suitable for varied SOFMED environments. We present the results of an online survey of Special Operations Medical Operators in an attempt to determine strengths and weaknesses of current systems. There was no consensus ideal hue for tactical illumination. Most Operators own three or more lights, and most lights were not night vision compatible. Most importantly, nearly 25% of respondents reported that lighting issues contributed to a poor casualty outcome; conversely, a majority (50 of 74) stated their system helped prevent a poor outcome. Based on the results of this initial survey, we can affirm that the design and choice of lighting is critical to SOFMED success. We are conducting ongoing studies to further define ideal systems for tactical applications including field, aviation, and marine settings.
DOI: 10.55460/ Digital Object Identifier
Objectives: To determine the prevalence and type of dietary supplement used, reasons for use, and sources of supplement information among Macedonian elite Soldiers. Methods: Anonymous self-reported questionnaires containing questions about demographic characteristics and dietary supplementation practices were distributed to 134 Soldiers, of whom 80 were recruited from the Ranger Battalion (R) and 54 from the Special Force Battalion (SF). Results: The Soldiers completed and returned 132 questionnaires. Overall, 66.6% of the Soldiers, including 70.3% of SF and 64.1% of R, reported using supplements within the 3 months before the survey. On average, each of these Soldiers used 3.7 ± 2.9 supplements. The most commonly used supplements were multivitamins (50.0%) and vitamin C (47.7%). The most frequently cited reason for using supplements was to improve general health (51.6%). Primary sources of supplement information were friends (42.0%) and books/magazines (40.9%). Conclusions: Dietary supplement use was found to be common and widespread among this military subpopulation. Given this, and the fact that the majority of the Soldiers do not receive accurate information about supplements, educational intervention regarding the safety and efficacy of these products is needed if unnecessary or harmful supplementation practices are to be prevented.
PMID: 23526317 PubMed Citation
DOI: 10.55460/EWOV-G9RZ Digital Object Identifier
Intraosseous access is becoming a lifesaving procedure under emergency conditions in Afghanistan's battlefield. The EZ-IO system (Vidacare, San Antonio, TX, USA) was successfully used in five patients in whom there was difficulty finding a peripheral venous access. The EZIO is an indispensable medical device to be used on the battlefield and during the evacuation of the wounded in a moving vehicle or helicopter.
PMID: 23526318 PubMed Citation
DOI: 10.55460/TGSS-A2P8 Digital Object Identifier
Introduction: The usefulness of heart rate variability (HRV) and heart rate complexity (HRC) analysis as a potential triage tool has been limited by the inability to perform real-time analysis on a portable, handheld monitoring platform. Through a multidisciplinary effort of academia and industry, we report on the development of a rugged, handheld and noninvasive device that provides HRV and HRC analysis in real-time in critically ill patients. Methods: After extensive re-engineering, real-time HRV and HRC analyses were incorporated into an existing, rugged, handheld monitoring platform. Following IRB approval, the prototype device was used to monitor 20 critically ill patients and 20 healthy controls to demonstrate real-world discriminatory potential. Patients were compared to healthy controls using a Student's t test as well as repeated measures analysis. Receiver operator characteristic (ROC) curves were generated for HRV and HRC. Results: Critically ill patients had a mean APACHE-2 score of 15, and over 50% were mechanically ventilated and requiring vasopressor support. HRV and HRC were both lower in the critically ill patients compared to healthy controls (ρ < 0.0001) and remained so after repeated measures analysis. The area under the ROC for HRV and HRC was 0.95 and 0.93, respectively. Conclusions: This is the first demonstration of real-time, handheld HRV and HRC analysis. This prototype device successfully discriminates critically ill patients from healthy controls. This may open up possibilities for real-world use as a trauma triage tool, particularly on the battlefield.
PMID: 23526319 PubMed Citation
DOI: 10.55460/RT7J-ZXWP Digital Object Identifier
Background: Common first aid tourniquets, like the Combat Application Tourniquet (CAT) of a windlass and band design, can have the band routed through the buckle in three different ways, and recent evidence indicates users may be confused with complex doctrine. Objective: The purpose of the present study is to measure the differential performance of the three possible routings in order to better understand good tourniquet practice. Methods: A training manikin was used by two investigators to measure tourniquet effectiveness, time to stop bleeding, and blood loss. Results: The effectiveness rate was 99.6% (239/240) overall. Results were similar for both single-slit routings (inside vs. outside, p > 0.05). Effectiveness rates (yes-no results for hemorrhage control expressed as a proportion of iterations) were not statistically different between single and double routing. However, the time to stop bleeding and blood loss were statistically different (ρ < 0.05). Conclusions: CAT band routing, through the buckle either singly or doubly, affects two key performance criteria: time to stop bleeding and volume of blood lost. Single routing proved to be faster, thereby saving more blood. Learning curves required to optimize user performance varied over 30-fold depending on which variable was selected (e.g., effectiveness vs. blood loss).
PMID: 23526320 PubMed Citation
DOI: 10.55460/W3VI-REYU Digital Object Identifier
Vestibular balance dysfunction has been documented as a military problem after duty-related barotrauma and/ or traumatic head acceleration. We are fostering the development of rapid, portable, fieldable tests of balance function after such vestibular insults. We consulted on military-relevant tests with more than 50 vestibular researchers, scientific advisors, clinicians, and biomedical engineers working for government agencies, universities, clinics, hospitals, or businesses. Screening tests and devices appropriate for early (post-injury) military functional assessment were considered. Based on these consultations, we recommend that military field tests emphasize dynamic, functional, and duty-relevant aspects of standing balance, gait, visual acuity, perception of visual vertical, and vertigo. While many current tests are useful for the clinic, they often require modification before they are suitable for military field and aid station settings. This report summarizes likely future military testing needs, giving priority to testing approaches in development that promise to be rapid, portable, field-ready, semiautomated, usable by a nonspecialist, and suitable during testing and rehabilitation.
PMID: 23526321 PubMed Citation
DOI: 10.55460/ZW27-XMRS Digital Object Identifier
Moeller DR. 13(1). 49 - 54. (Journal Article)
This large case series reports the results of using a removable soft intraoral stabilization splint in the treatment of chronic headaches and chronic nightmares in 60 military post-traumatic stress disorder (PTSD) patients of the Vietnam, Desert Storm, Operation Iraqi Freedom, and Operation Enduring Freedom conflicts. Patient treatment criteria included meeting all of the following requirements: minimum of three headaches per week; minimum of three nightmares per week; minimum of three sleep interruptions per week; minimum of three intraoral or extraoral (craniofacial) trigger points; and previous PTSD diagnosis by the U.S. Army or Veterans Administration with duration of this disorder for a minimum of three years. Significant reduction (60%-90%) in headache and nightmare severity, intensity, and duration was obtained in 75% of the 44 patients who completed the three-month follow-up.
PMID: 23526322 PubMed Citation
DOI: 10.55460/JY7G-94LF Digital Object Identifier
Incorporation of point-of-care ultrasound into the skill set of Special Operations medical providers should come with an appreciation of the potential limitations of the technology. We present a case of a U.S. Army Special Forces Soldier who suffered traumatic monocular vision loss after being struck in the eye during a combatives tournament. Evaluation in the emergency department (ED) included an unremarkable ocular ultrasound, despite a high clinical suspicion of intraocular pathology. Ophthalmologic consultation was obtained emergently. Optical coherence topography and a dilated fundoscopic examination were performed, which revealed a small subretinal hemorrhage. We will review the history of ocular ultrasound and its sensitivity to detect intraocular pathology. We will also emphasize the need to obtain specialty consultation when the clinical suspicion for intraocular pathology is high despite a negative ocular ultrasound.
PMID: 23526323 PubMed Citation
DOI: 10.55460/H01L-L6O7 Digital Object Identifier
Background: This report describes the case of a Soldier who sustained a gunshot wound from a 9mm to the distal phalanx and presented to the authors while they were deployed on a recent joint training mission to Southwest Asia.
PMID: 23526324 PubMed Citation
DOI: 10.55460/T3FS-GI2Y Digital Object Identifier
Lamellar ichthyosis (LI) is a rare inherited skin disorder of cornification, with an incidence of approximately 1 in 200,000 births. It is one of three types of autosomal recessive congenital ichthyosis (ARCI), a collective term for the spectrum of nonsyndromic ichthyoses caused by a number of well-described genetic mutations. We describe the case of LI diagnosed in a 10-day-old child of a Somali refugee at a free clinic in downtown Djibouti. Initial concern was for staphylococcal infection versus congenital disease. With the use of digital photographs, consultation with experts accessed through the Army Teledermatology Consultation Service supported a diagnosis of ARCI. Providing care to patients in austere environments can present numerous medical challenges. A provider cannot be expected to be able to diagnose and treat every disease and disorder alone, especially if there is a language barrier. Telemedicine can help close the gap in knowledge, particularly when presented with a challenging case. With a novel presentation, simply taking a photograph and e-mailing a consultant can quickly augment one's medical acumen, ensuring appropriate diagnosis and treatment.
PMID: 23526325 PubMed Citation
DOI: 10.55460/PGFE-Y5GL Digital Object Identifier
Burnett MW. 13(1). 66 - 67. (Journal Article)
PMID: 23526326 PubMed Citation
DOI: 10.55460/Q1KH-JDKS Digital Object Identifier
PMID: 23526327 PubMed Citation
DOI: 10.55460/M1TR-0H3T Digital Object Identifier
Hester RA. 13(1). 72 - 72. (Book Review)
William F. Sine
Casemate Publishers. 9/19/2012. ISBN-13: 9781612001227
DOI: 10.55460/ Digital Object Identifier
Bollard GA. 13(1). 73 - 73. (Book Review)
Jeffrey D. Ho, MD; Donald M. Dawes, MD; Mark W. Kroll, PhD
Springer, 2012, 204 pages.
DOI: 10.55460/ Digital Object Identifier
DOI: 10.55460/ Digital Object Identifier