Iraq war injuries.
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Amputation, Surgical↗
Biomedical subjects
Dana C Covey
Publications and source records attributed to Dana C Covey.
Levels of medical care in the global war on terrorism.
Trauma care for military personnel injured in Iraq has become increasingly sophisticated. There are five levels, or echelons, of care, each progressively more advanced. Level I care provides immediate first aid at the front line. Level II care consists of surgical resuscitation provided by highly mobile forward surgical teams that directly support combatant units in the field. Level III care is provided through combat support hospitals--large facilities that take time to become fully operational but offer much more advanced medical, surgical, and trauma care, similar to a civilian trauma center. Level IV care is the first echelon at which definitive surgical management is provided outside the combat zone. Level V care is the final stage of evacuation to one of the major military centers in the United States, where definitive stabilization, reconstruction, or amputation of the injured extremity is performed.
Delivery of Health Care↗
Combat orthopaedics: a view from the trenches.
Approximately 70% of war wounds involve the musculoskeletal system, and military orthopaedic surgeons have assumed a pivotal role in the frontline treatment of these injuries in Iraq. Providing battlefield orthopaedic care poses special challenges; not only are many wounds unlike those encountered in civilian practice, but patients also must be triaged and treated in an austere and dangerous environment, undergo staged resuscitation and definitive surgery, and endure prolonged medical evacuation, often involving ground, helicopter, and fixed-wing transport across continents. Most orthopaedic wounds in Iraq are caused by exploding ordnance--frequently, improvised explosive devices, or IEDs. Because of advances in care, rapid medical evacuation, and modern body armor, many casualties have survived in Iraq who would not have done so in previous wars. Treatment of war wounds, many of which are devastating in the scope of soft-tissue and bony injury, requires a team approach using hypotensive resuscitation, damage-control orthopaedics, new or rediscovered techniques of hemostatic and intravenous hemorrhage control, vacuum-assisted wound closure, and advanced reconstruction. Current challenges include prevention of infection, a better understanding of heterotopic ossification as a sequela of blast injury, and the need for a comprehensive, joint service database that encompasses the multilevel spectrum of orthopaedic care.
Humans↗
The effects of varied joint motion and loading conditions on posterior cruciate ligament fiber length behavior.
BACKGROUND: The posterior cruciate ligament has been described as being composed of 2 bands that reciprocally tighten and loosen with knee flexion, but the fiber anatomy and behavior may be more complex. HYPOTHESIS: The mechanical effects of defined loading conditions at discrete knee joint angles can vary significantly within the substance of the posterior cruciate ligament depending on the fiber region tested. STUDY DESIGN: Controlled laboratory study. METHODS: Nine intact, fresh-frozen cadaveric knees were instrumented with excursion filaments implanted within 4 fiber regions of the posterior cruciate ligament. Patterns of fiber behavior were analyzed as a function of the variable linear separation distance between tibial and femoral fiber attachment sites during joint motion under a simulated quadriceps contraction, tibial internal rotation, and tibial external rotation. Analysis of variance, the Newman-Keuls multiple comparisons procedure, and paired t tests were used to evaluate statistical significance. RESULTS: Compared with the control pattern of fiber behavior during unloaded passive knee motion from 0 degrees to 120 degrees , the quadriceps force caused loosening of most ligament fibers at knee flexion of less than 75 degrees . Tibial internal rotation significantly slackened the anterior and central fiber regions near extension and significantly tightened the central and posterior fiber regions with progressive flexion. External rotation had an effect similar to internal rotation on the anterior and central fiber regions but caused significant slackening of the posterior fiber regions from 0 degrees to 45 degrees . CONCLUSIONS: Distinct geographic regions within the posterior cruciate ligament have different functional roles depending on the joint angle and the type of load to which the knee is subjected. CLINICAL RELEVANCE: The specific graft placement parameters in a given surgical procedure relate to end-to-end length changes of the graft and may have important implications for postoperative rehabilitation and return to specific functional activities.
Adult↗
Musculoskeletal war wounds during Operation BRAVA in Sri Lanka.
Operation BRAVA (Blast Resuscitation and Victim Assistance) was conceived as a means of conducting humanitarian assistance, education, and training in the acute surgical management of land mine and other blast injuries. The first Operation BRAVA mission was carried out in Sri Lanka during 1998 at a time of civil war between government forces and Tamil separatists. Thirty-seven patients with orthopedic war wounds were seen during this mission because of the fighting. Exploding ordnance injured 24 patients (65%), and 13 patients (35%) sustained gunshot wounds. Sixty-seven percent of explosive injuries were from mortar rounds, and the remainder was from a variety of detonating munitions. Twenty-two patients (59%) sustained injuries to one or both lower limbs, and compartment syndrome of the leg developed in two of these patients as a result of multiple fragment injuries. Nine patients (24%) sustained concomitant neurological or vascular injuries. Operation BRAVA provided a novel approach to enhancing the combat medical skills of U.S. military personnel and was successful in developing working relationships with host country medical professionals, facilitating participation in the care of wounded patients, and establishing a framework upon which future BRAVA teams might build.
Adolescent↗
Ambulatory surgery in a navy fleet hospital training set.
A series of 51 active duty patients who elected to undergo ambulatory surgery in a Navy Fleet Hospital Training Set (a modified field hospital) over a 2-year period were followed prospectively for perioperative complications. All patients were active duty personnel, ranging in grade from E1 to O5, who voluntarily gave specific informed consent to have their surgery performed in the training set. Patients were offered surgery in the training set only if attending surgeons were confident that the surgery could be done safely and with the same expected outcome as if performed in the hospital. Their entire surgical experience was contained within this tent-based field facility from admission to discharge. There were 12 orthopedic surgery, 4 general surgery, 3 otolaryngology, 2 urology, 1 ophthalmology, and 29 oral and maxillofacial surgery cases. General, regional, or local anesthesia or intravenous conscious sedation were used as indicated. No patients developed wound infections, and there were no anesthetic, bleeding, or other significant perioperative complications. Selected ambulatory surgical procedures can be safely performed on appropriate patients in this field hospital assemblage.
Adolescent↗
Blast and fragment injuries of the musculoskeletal system.
Blast and fragment injuries of the musculoskeletal system are the most frequently encountered wounds in modern warfare. Most injuries to the musculoskeletal system involve so-called secondary blast injuries in which casing fragments and other debris become flying projectiles. Nonoperative treatment of selected wounds caused by small-fragment debris has been successful but remains controversial. Successful surgical treatment depends on meticulous wound débridement, with excision of nonviable tissue and foreign material likely to cause infection; adequate drainage; and delayed closure. Advanced internal fixation techniques used in modern trauma centers to treat predominantly blunt trauma may not be appropriate for care of orthopaedic war wounds in a field setting.
Blast Injuries↗