WASHINGTON, DC—Military and civilian medical facilities are collaborating to improve care and treatment for servicemembers who have sustained major extremity injuries in a newly established extremity trauma research consortium.

The Major Extremity Trauma Research Consortium will be funded by the Department of Defense for $18.5 million over five years. The consortium will work closely with the US Army Institute of Surgical Research and will consist of 12 civilian medical centers and four military treatment centers that will enroll patients who have sustained severe wounded extremities in multi-center clinical research projects undertaken by the consortium. The Johns Hopkins Bloomberg School of Public Health will serve as the Data Coordinating Center for the consortium.

Severe limb extremity injuries are a major medical concern in the military. As of Oct 2, 35,653 servicemembers have been injured in the conflicts in Iraq and Afghanistan. Approximately 82% of all battlefield-injured soldiers returning from the current conflicts have at least one extremity injury, and penetrating soft tissue wounds and open fractures make up many of these wounds.

Improving Care For Extremity Injuries

Research is needed to better understand how best to care for patients with severe injuries, according to Dr Joseph C. Wenke, PhD, the program manager for the USAISR. The studies undertaken by the consortium will address clinical areas important to the military, such as how to improve the healing of severe open fractures and determining how best to manage musculoskeletal infections.

Doctor Wenke said that the consortium’s studies are not focusing on experimental treatments, but will compare standard medical treatments to determine what works best. What the consortium learns will be used to help physicians formulate treatment plan for patients who have sustained a serious limb injury and to facilitate the translation of emerging technologies into clinical practice.

An example of one of the study questions the consortium will focus on is how to best prevent infections in patients with extremity injuries. “If there is an already established infection, how can you treat it? Right now, there really hasn’t been a large systematic approach on what types of antibiotic regimen will reduce the infection rate,” said Dr Wenke.

Collaborating with Civilian Medicine

The consortium will pursue research that will be military relevant. Both military and civilian patients will be enrolled in the studies. No one center has enough patients to enroll in these trials. By utilizing several civilian trauma centers, there will be enough seriously injured participants participating to make a difference. “We are talking about enrolling higher energy injuries that are more relevant to our patient population. If we only had one or two centers, you just wouldn’t have the patient volume to select that small percentage of injuries that are relevant to what we see [in the military],” he said.

Each of the injuredpatients enrolled will be followed for two years.The follow-up will consist of examining the qualityof life for the patient and the clinical and functional outcome for the patient. “Does this affect the person? Does it affect their social life or work? Can they take care of themselves? Is their quality of care worse? The functional outcome is more the injury or anatomical site specific. Can the person actually walk upstairs?” said Dr Wenke.

The studies will also benefit civilian medicine, according to Dr Renn Crichlow, an orthopedic trauma surgeon at OrthoIndy and the Indiana Orthopaedic Hospital, who noted that civilians also experience severe limb trauma. “An improvised explosive device or a landmine can do pretty catastrophic damage to someone’s foot, leg or knee, but so can falling off a motorcycle at 90 miles per hour. We do see a lot of motorcycle crashes, a lot of industrial injuries, that mimic the kind of things that are seen in wartime,” he told U.S. Medicine.

His center treats anywhere from 30 to 50 of these types of severe extremity injuries a year. It is hoped about half of these patients can be enrolled in the studies. “They are pretty rare injuries, so that’s why we have so many different centers participating,” said Dr Crichlow.

The studies have the potential to shed light on many important areas, he explained. “If we can make an impact on a person’s psychology when they get one of these injuries, I think we have a really good opportunity to change their outcome. If we can decrease on the infection rates or get a handle on infections in a very aggressive way, and know which of the ways we treat infections is optimal, I think that will be a huge step forward.”

Doctor Michael Bosse of Carolinas Medical Center’s (CMC) Department of Orthopedic Surgery will serve as the chair of the consortium.

The 12 core clinical centers currently participating in the consortium include:

• Boston University Medical Center
• The Florida Orthopaedic Institute
• Carolinas Medical Center
• Denver Health and Hospital Authority
• OrthoIndy and the Indiana Orthopaedic Hospital
• Orthopaedic Associates of Michigan
• The Orthopaedic Trauma Institute at the University of California at San Francisco
• San Francisco General Hospital
• The University of Maryland Medical Systems, R Adams Cowley Shock Trauma Center
• The University of Mississippi Medical Center
• The University of Texas Southwestern Medical Center
• The University of Washington Harborview Medical Center
• Vanderbilt University Medical Center

The MTFs participating are:

• Brooke Army Medical Center
• Walter Reed Army Medical Center
• Naval Medical Center San Diego
• Naval Medical Center Portsmouth

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