Prevention and management of infections associated with combat-related extremity injuries

Clinton K. Murray, Joseph R. Hsu, Joseph S. Solomkin, John J. Keeling, Romney C. Andersen, James Robert Ficke, Jason H. Calhoun

Research output: Contribution to journalArticle

Abstract

Orthopedic injuries suffered by casualties during combat constitute approximately 65% of the total percentage of injuries and are evenly distributed between upper and lower extremities. The high-energy explosive injuries, environmental contamination, varying evacuation procedures, and progressive levels of medical care make managing combat-related injuries challenging. The goals of orthopedic injury management are to prevent infection, promote fracture healing, and restore function. It appears that 2% to 15% of combat-related extremity injuries develop osteomyelitis, although lower extremity injuries are at higher risk of infections than upper extremity. Management strategies of combat-related injuries primarily focus on early surgical debridement and stabilization, antibiotic administration, and delayed primary closure. Herein, we provide evidence-based recommendations from military and civilian data to the management of combat-related injuries of the extremity. Areas of emphasis include the utility of bacterial cultures, antimicrobial therapy, irrigation fluids and techniques, timing of surgical care, fixation, antibiotic impregnated beads, wound closure, and wound coverage with negative pressure wound therapy. Most of the recommendations are not supported by randomized controlled trials or adequate cohorts studies in a military population and further efforts are needed to answer best treatment strategies.

Original languageEnglish (US)
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume64
Issue numberSUPPL. 3
DOIs
StatePublished - Mar 2008
Externally publishedYes

Fingerprint

Extremities
Wounds and Injuries
Infection
Orthopedics
Lower Extremity
Negative-Pressure Wound Therapy
Anti-Bacterial Agents
Fracture Healing
Fluid Therapy
Debridement
Osteomyelitis
Upper Extremity
Cohort Studies
Randomized Controlled Trials
Population

Keywords

  • Combat
  • Extremity
  • Infection
  • Trauma

ASJC Scopus subject areas

  • Surgery

Cite this

Prevention and management of infections associated with combat-related extremity injuries. / Murray, Clinton K.; Hsu, Joseph R.; Solomkin, Joseph S.; Keeling, John J.; Andersen, Romney C.; Ficke, James Robert; Calhoun, Jason H.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 64, No. SUPPL. 3, 03.2008.

Research output: Contribution to journalArticle

Murray, Clinton K. ; Hsu, Joseph R. ; Solomkin, Joseph S. ; Keeling, John J. ; Andersen, Romney C. ; Ficke, James Robert ; Calhoun, Jason H. / Prevention and management of infections associated with combat-related extremity injuries. In: Journal of Trauma - Injury, Infection and Critical Care. 2008 ; Vol. 64, No. SUPPL. 3.
@article{7f581358611e4ce195f20defab46f64f,
title = "Prevention and management of infections associated with combat-related extremity injuries",
abstract = "Orthopedic injuries suffered by casualties during combat constitute approximately 65{\%} of the total percentage of injuries and are evenly distributed between upper and lower extremities. The high-energy explosive injuries, environmental contamination, varying evacuation procedures, and progressive levels of medical care make managing combat-related injuries challenging. The goals of orthopedic injury management are to prevent infection, promote fracture healing, and restore function. It appears that 2{\%} to 15{\%} of combat-related extremity injuries develop osteomyelitis, although lower extremity injuries are at higher risk of infections than upper extremity. Management strategies of combat-related injuries primarily focus on early surgical debridement and stabilization, antibiotic administration, and delayed primary closure. Herein, we provide evidence-based recommendations from military and civilian data to the management of combat-related injuries of the extremity. Areas of emphasis include the utility of bacterial cultures, antimicrobial therapy, irrigation fluids and techniques, timing of surgical care, fixation, antibiotic impregnated beads, wound closure, and wound coverage with negative pressure wound therapy. Most of the recommendations are not supported by randomized controlled trials or adequate cohorts studies in a military population and further efforts are needed to answer best treatment strategies.",
keywords = "Combat, Extremity, Infection, Trauma",
author = "Murray, {Clinton K.} and Hsu, {Joseph R.} and Solomkin, {Joseph S.} and Keeling, {John J.} and Andersen, {Romney C.} and Ficke, {James Robert} and Calhoun, {Jason H.}",
year = "2008",
month = "3",
doi = "10.1097/TA.0b013e318163cd14",
language = "English (US)",
volume = "64",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "SUPPL. 3",

}

TY - JOUR

T1 - Prevention and management of infections associated with combat-related extremity injuries

AU - Murray, Clinton K.

AU - Hsu, Joseph R.

AU - Solomkin, Joseph S.

AU - Keeling, John J.

AU - Andersen, Romney C.

AU - Ficke, James Robert

AU - Calhoun, Jason H.

PY - 2008/3

Y1 - 2008/3

N2 - Orthopedic injuries suffered by casualties during combat constitute approximately 65% of the total percentage of injuries and are evenly distributed between upper and lower extremities. The high-energy explosive injuries, environmental contamination, varying evacuation procedures, and progressive levels of medical care make managing combat-related injuries challenging. The goals of orthopedic injury management are to prevent infection, promote fracture healing, and restore function. It appears that 2% to 15% of combat-related extremity injuries develop osteomyelitis, although lower extremity injuries are at higher risk of infections than upper extremity. Management strategies of combat-related injuries primarily focus on early surgical debridement and stabilization, antibiotic administration, and delayed primary closure. Herein, we provide evidence-based recommendations from military and civilian data to the management of combat-related injuries of the extremity. Areas of emphasis include the utility of bacterial cultures, antimicrobial therapy, irrigation fluids and techniques, timing of surgical care, fixation, antibiotic impregnated beads, wound closure, and wound coverage with negative pressure wound therapy. Most of the recommendations are not supported by randomized controlled trials or adequate cohorts studies in a military population and further efforts are needed to answer best treatment strategies.

AB - Orthopedic injuries suffered by casualties during combat constitute approximately 65% of the total percentage of injuries and are evenly distributed between upper and lower extremities. The high-energy explosive injuries, environmental contamination, varying evacuation procedures, and progressive levels of medical care make managing combat-related injuries challenging. The goals of orthopedic injury management are to prevent infection, promote fracture healing, and restore function. It appears that 2% to 15% of combat-related extremity injuries develop osteomyelitis, although lower extremity injuries are at higher risk of infections than upper extremity. Management strategies of combat-related injuries primarily focus on early surgical debridement and stabilization, antibiotic administration, and delayed primary closure. Herein, we provide evidence-based recommendations from military and civilian data to the management of combat-related injuries of the extremity. Areas of emphasis include the utility of bacterial cultures, antimicrobial therapy, irrigation fluids and techniques, timing of surgical care, fixation, antibiotic impregnated beads, wound closure, and wound coverage with negative pressure wound therapy. Most of the recommendations are not supported by randomized controlled trials or adequate cohorts studies in a military population and further efforts are needed to answer best treatment strategies.

KW - Combat

KW - Extremity

KW - Infection

KW - Trauma

UR - http://www.scopus.com/inward/record.url?scp=43149091480&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=43149091480&partnerID=8YFLogxK

U2 - 10.1097/TA.0b013e318163cd14

DO - 10.1097/TA.0b013e318163cd14

M3 - Article

C2 - 18316968

AN - SCOPUS:43149091480

VL - 64

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - SUPPL. 3

ER -