The Evolution of Modern Combat Orthopaedic Care From Clinical Investigation to Battlefield Application: Three Decades of Research to Decrease Morbidity and Mortality

Over 52,000 US service members were wounded in the wars in Iraq and Afghanistan over two decades of war. These years also witnessed a continued evolution in the treatment of polytraumatized patients, especially those injured in combat. Because most of those wounded in action sustain musculoskeletal injuries, providing skilled treatment as soon as possible after injury has saved the lives of numerous service members and improved the musculoskeletal function of those injured in these conflicts. Orthopaedic surgeons have been crucial members of forward surgical teams that have performed life and limb-saving care under challenging forward-deployed conditions, sometimes under fire. In this setting, military orthopaedic surgery has continued to evolve, building in part on experience gained in smaller conflicts where the United States was not a principal belligerent but where war trauma familiarity was acquired that contributed to improvements in forward orthopaedic care during the recent wars in Iraq and Afghanistan. The presented body of work addresses multiple facets of orthopaedic combat care including the intermingling of surgeon and team preparation, logistics, clinical studies, and the concept of far forward surgical treatment, to increase survival and improve outcomes of those sustaining acute battlefield musculoskeletal trauma.