Pelvic, spinal and extremity wounds among combat-specific personnel serving in Iraq and Afghanistan (2003-2011): A new paradigm in military musculoskeletal medicine

Introduction: Previous studies regarding musculoskeletal injuries sustained during war have been limited by a lack of specificity regarding wounds incurred by combat-specific personnel. This investigation endeavoured to develop a comprehensive catalogue of the extent of musculoskeletal trauma, as well as the frequency of distinct injuries, among soldiers possessing a single combat-specific specialty.

Methods: The Department of Defense Trauma Registry (DoDTR) and the Armed Forces Medical Examiner System (AFMES) were queried for all individuals with the combat-specific designation of cavalry scout who sustained injuries during deployment between the years 2003 and 2011. This data was refined to include only those soldiers found to have injuries involving the spine, pelvis, or extremities. Soldier age, rank, injury location (Afghanistan or Iraq), injury scenario (combat vs. non-combat) and mechanism of wounding were recorded, as were injury-specific data. Statistical comparisons for categorical variables were made using the chi-square statistic.

Results: Sixty-seven percent (n=472) of 701 cavalry scouts injured during deployment sustained one or more injuries to the musculoskeletal system. Mean age for the group was 25.9 (range 18-54) years and 3.3 musculoskeletal injuries were incurred on average per casualty. The majority of casualties occurred during combat and in the Iraq theatre. Sixty-nine percent (n=328) of musculoskeletal casualties were incurred following explosion, and 20% (n=94) occurred due to gunshot. No significant difference (p>0.05) was encountered for the risk of musculoskeletal injury by wound mechanism. Forty-six percent of all injuries involved the lower extremities, while 32% occurred in the upper extremities. Tibial fractures were the most common injury encountered (8%), while amputations comprised 11% of all wounds. Spinal cord injury occurred in 12% of all casualties and represented 4% of all musculoskeletal wounds.

Conclusions: This effort is among the first to combine complimentary data from the DoDTR and AFMES over a multi-year period in order to comprehensively catalogue musculoskeletal wounds sustained by combat-specific soldiers. This investigation highlights a 49% incidence of injuries involving the spine, pelvis, and/or extremities within a cohort of combat-specific soldiers. Elevated rates of amputations, spinal injuries, and pelvic trauma were also appreciated as compared to earlier reports.