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Greatest Threat to Our Military Fighting Strength

You might not realize it but musculoskeletal injuries from explosions and gunshot wounds disable more soldiers than any other battlefield trauma. In fact, according to a study done by the United States Army, even when other bodily trauma occurs, it's still the orthopedic injury that creates disability leading to discharge from the military. And that reduces our military's fighting strength in the current Iraqi war.

In order to better understand the problem (and find a solution), the Army Physical Evaluation Board reviewed the records of all service members hurt in the line of duty over a four year period of time. They were collecting information to help identify patterns of injuries.

More then two-thirds of the injuries had an orthopedic component (damage to bones, skin, muscles, tendons, ligaments, and/or other soft tissues). A full 57 per cent were orthopedic only. All of the injuries reviewed left the soldier unfit for duty, which in turn, reduces our military strength and readiness.

Having a clear understanding of the types of injuries (musculoskeletal and nonmusculoskeletal) is important. Tallying up areas of the body affected most often and the mechanism of injury (how it happened) helps military health care officials prepare long-term treatment plans. They refer to this as combat casualty care.

Research like this to characterize wounded soldiers will help at every level. Care for the wounded soldier begins on the battlefield and continues as the combat veteran seeks services as a disabled civilian. Planning and allocating resources (personnel and programs and the money for both) to provide these services depends on information of this type.

As it turns out, orthopedic injuries that occur on the battlefield and lead to permanent disability happen more often than anyone in the military realized. For example, scar tissue affecting the arms or legs, pain, spinal cord injuries, nerve damage, and amputations are just some of the conditions that leave a soldier unfit for duty.

A closer look showed that degenerative arthritis was actually the most common condition, arm amputation created the greatest disability, and amputation of the leg affected the soldier in all areas the most (e.g., return to duty, long-term outcome). It's very likely that the total cost of rehab for battlefield orthopedic conditions and long-term disability paid out is much greater than anyone anticipated.

In summary, this is the first study to look at battlefield injuries by type, severity, frequency, and impact. Combat casualty is high. Battle injuries and resulting disability are permanently affecting U.S. military strength.

Only one per cent of orthopedically injured soldiers involved in Operation Iraqi Freedom and Operation Enduring Freedom return to active duty. Future research must be directed toward improved outcomes including returning more service members to active-duty with fewer and less severe disabilities.

References: CPT Jessica D. Cross, MD, et al. Battlefield Orthopaedic Injuries Cause the Majority of Long-Term Disabilities. In Journal of the American Academy of Orthopaedic Surgeons. Vol. 19. Supplement 1. Pp. S1-S7.

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