{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:14:35Z","timestamp":1781741675344,"version":"3.54.5"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"11-12","funder":[{"DOI":"10.13039\/100016156","name":"U.S. Army Medical Research and Development Command","doi-asserted-by":"publisher","award":["W81XWH-21-2-0004"],"award-info":[{"award-number":["W81XWH-21-2-0004"]}],"id":[{"id":"10.13039\/100016156","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100016156","name":"U.S. Army Medical Research and Development Command","doi-asserted-by":"publisher","award":["W81XWH-21-2-0004"],"award-info":[{"award-number":["W81XWH-21-2-0004"]}],"id":[{"id":"10.13039\/100016156","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,11,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>In prolonged care scenarios, where medical evacuations are significantly delayed, the treatment and transport of casualties with extremity musculoskeletal injuries will drain combat units\u2019 human resources. Developing enhanced splinting techniques to restore casualty mobility and function can alleviate this drain. To guide this development, a panel of tactical combat and wilderness medicine experts was assembled to determine which extremity musculoskeletal injuries had the greatest impact on unit capabilities, and the materials available for splinting these injuries.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Information Gathering<\/jats:title>\n                  <jats:p>Unstructured consultations with panel members yielded preliminary lists of injuries and materials. These lists were consolidated and redistributed to panel members for final evaluation where they ranked the injuries based on frequency and human resource cost and assessed the accessibility of materials. Responses for the final evaluation were statistically analyzed using Wilcoxon rank-sum tests and Placket Luce models.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Lessons Learned<\/jats:title>\n                  <jats:p>Aggregated responses indicated that panel members thought that knee and ankle ligamentous injuries and radial head fractures were the most frequently occurring injuries, although closed distal femoral fractures, below knee amputations, and open tibia fractures would require the most demand for injury care. Assessing the combined impact of frequency and human resource cost indicated that knee and ankle ligamentous injuries and closed tibia fractures had the greatest impact on unit readiness. Responses also indicated that a variety of materials would be available for applying or improvising splints.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Although the combined impact of knee and ankle ligamentous injuries were ranked the highest, limitations in relative rankings and the existence of effective low-cost treatments for these injuries suggest that greater gains in unit effectiveness would come from focusing on developing solutions for fractures with higher human resource cost, such as leg and arm fractures. This information can be used to develop enhanced splints that can preserve unit readiness in the field.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usae404","type":"journal-article","created":{"date-parts":[[2024,9,20]],"date-time":"2024-09-20T15:58:19Z","timestamp":1726847899000},"page":"2731-2738","source":"Crossref","is-referenced-by-count":1,"title":["Identifying Improvements in Treating Extremity Musculoskeletal Injuries During Prolonged Care"],"prefix":"10.1093","volume":"189","author":[{"given":"W Brett","family":"Johnson","sequence":"first","affiliation":[{"name":"Extremity Trauma and Amputation Center of Excellence , JBSA Ft. Sam Houston, TX 78234,","place":["USA"]},{"name":"Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center , JBSA Ft. Sam Houston, TX 78234,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1447-6179","authenticated-orcid":false,"given":"Antuione D","family":"Perry","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center , JBSA Ft. Sam Houston, TX 78234,","place":["USA"]},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. , Bethesda, MD 20817,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9139-8760","authenticated-orcid":false,"given":"Garrett","family":"Flores","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center , JBSA Ft. Sam Houston, TX 78234,","place":["USA"]},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. , Bethesda, MD 20817,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah N","family":"Pierrie","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, San Antonio Military Medical Center (or Brooke Army Medical Center) , JBSA Ft. Sam Houston, TX 78234,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Joseph F","family":"Alderete","sequence":"additional","affiliation":[{"name":"U.S. Army Institute of Surgical Research, Brooke Army Medical Center , JBSA Ft. Sam Houston, TX 78234,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Allen","sequence":"additional","affiliation":[{"name":"University of Texas Health Science Center , San Antonio, TX 78229,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Wilson","sequence":"additional","affiliation":[{"name":"Alabama College of Osteopathic Medicine , Dothan, AL 36303,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"King","sequence":"additional","affiliation":[{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. , Bethesda, MD 20817,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6119-983X","authenticated-orcid":false,"given":"W Lee","family":"Childers","sequence":"additional","affiliation":[{"name":"Extremity Trauma and Amputation Center of Excellence , JBSA Ft. Sam Houston, TX 78234,","place":["USA"]},{"name":"Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center , JBSA Ft. Sam Houston, TX 78234,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,9,20]]},"reference":[{"key":"2024110620113607300_R1","article-title":"The US Army in Multi-Domain Operations 2028","volume-title":"TRADOC Pamphlet 525-3-1","author":"US Army Training and Doctrine Command"},{"issue":"2","key":"2024110620113607300_R2","article-title":"Causes of medical evacuations from Operations Iraqi Freedom (OIF), New Dawn (OND) and Enduring Freedom (OEF), active and reserve components, US Armed Forces, October 2001-September 2010","volume":"18","author":"Armed Forces Health Surveillance Center","year":"2011","journal-title":"Med Surveillance Mon Rep"},{"issue":"4","key":"2024110620113607300_R3","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1097\/BOT.0b013e31802f78fb","article-title":"Characterization of extremity wounds in operation Iraqi freedom and operation enduring Freedom","volume":"21","author":"Owens","year":"2007","journal-title":"J Orthop Trauma"},{"issue":"7","key":"2024110620113607300_R4","doi-asserted-by":"publisher","first-page":"469","DOI":"10.7205\/MILMED-D-10-00041","article-title":"Disease and nonbattle injuries sustained by a US Army Brigade Combat team during operation Iraqi Freedom","volume":"175","author":"Belmont","year":"2010","journal-title":"Mil Med"},{"issue":"1","key":"2024110620113607300_R5","doi-asserted-by":"publisher","first-page":"E1","DOI":"10.1097\/TA.0b013e3181edebed","article-title":"Combat musculoskeletal wounds in a US Army Brigade Combat Team during operation Iraqi Freedom","volume":"71","author":"Belmont","year":"2011","journal-title":"J Trauma"},{"issue":"1","key":"2024110620113607300_R6","doi-asserted-by":"publisher","first-page":"S94","DOI":"10.1016\/j.amepre.2009.10.022","article-title":"Frequency and causes of nonbattle injuries air evacuated from Operations Iraqi Freedom and Enduring Freedom, US Army, 2001\u20132006","volume":"38","author":"Hauret","year":"2010","journal-title":"Am J Preventive Med"},{"issue":"3","key":"2024110620113607300_R7","doi-asserted-by":"publisher","first-page":"91","DOI":"10.55460\/QM3U-JZB1","article-title":"Mobility solutions after a lower extremity fracture and applicability to battlefield and wilderness medicine","volume":"23","author":"Childers","year":"2023","journal-title":"J Spec Oper Med"},{"issue":"4","key":"2024110620113607300_R8","doi-asserted-by":"publisher","DOI":"10.1177\/2473011419S00297","article-title":"Fracture immobilization in an austere environment: a comparative study of military special operations medical personnel using a SAM splint vs a one-step spray on foam","volume":"4","author":"Martin","year":"2019","journal-title":"Foot Ankle Orthop"},{"issue":"2","key":"2024110620113607300_R9","doi-asserted-by":"publisher","first-page":"46","DOI":"10.55460\/074X-GZAQ","article-title":"Evaluation of commercially available traction splints for battlefield use","volume":"14","author":"Studer","year":"2014","journal-title":"J Spec Oper Med"},{"issue":"4","key":"2024110620113607300_R10","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1302\/0301-620X.91B4.21962","article-title":"The Thomas splint: its origins and use in trauma","volume":"91","author":"Robinson","year":"2009","journal-title":"J Bone Joint Surg Br Vol"},{"issue":"1","key":"2024110620113607300_R11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.33151\/ajp.17.769","article-title":"Are you pulling my leg? Does the use of traction splints in the pre-hospital management of patients with femur fractures reduce the complications compared to traditional splinting?","volume":"17","author":"Syme","year":"2020","journal-title":"Australas J Paramed"},{"issue":"4","key":"2024110620113607300_R12","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1136\/jramc-149-04-09","article-title":"The Thomas splint\u2013a necessary tool in the management of battlefield injuries","volume":"149","author":"Rowlands","year":"2003","journal-title":"BMJ Mil Health"},{"key":"2024110620113607300_R13","volume-title":"Diseases of the Hip, Knee, and Ankle Joints, with Their Deformities, Treated by a New and Efficient Method","author":"Thomas","year":"1878"},{"issue":"4","key":"2024110620113607300_R14","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1097\/01.JTN.0000343323.47463.aa","article-title":"Implementation of a Combat Casualty Trauma Registry","volume":"15","author":"Glenn","year":"2008","journal-title":"J Trauma Nurs"},{"issue":"5","key":"2024110620113607300_R15","doi-asserted-by":"publisher","first-page":"546","DOI":"10.7205\/MILMED-D-11-00422","article-title":"Evaluating the joint theater trauma registry as a data source to benchmark casualty care","volume":"177","author":"O\u2019Connell","year":"2012","journal-title":"Mil Med"},{"issue":"S2","key":"2024110620113607300_R16","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1093\/milmed\/usac050","article-title":"Department of defense trauma registry infectious disease module impact on clinical practice","volume":"187","author":"Tribble","year":"2022","journal-title":"Mil Med"},{"issue":"7-8","key":"2024110620113607300_R17","doi-asserted-by":"publisher","first-page":"e1073","DOI":"10.1093\/milmed\/usz481","article-title":"Exploring nonbattle injury in the deployed military environment using the Department of Defense Trauma Registry","volume":"185","author":"Kauver","year":"2020","journal-title":"Mil Med"},{"issue":"2","key":"2024110620113607300_R18","doi-asserted-by":"publisher","first-page":"49","DOI":"10.55460\/1EOJ-0HRV","article-title":"An analysis of prehospital trauma registry after-action review in Afghanistan","volume":"21","author":"Carius","year":"2021","journal-title":"J Spec Oper Med"},{"issue":"Suppl _1","key":"2024110620113607300_R19","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1097\/01.ccm.0000528322.39346.3a","article-title":"A review of casualties transported to role 2 medical treatment facilities in Afghanistan","volume":"183","author":"Kotwal","year":"2018","journal-title":"Mil Med"},{"key":"2024110620113607300_R20","volume-title":"Individual Choice Behavior: A Theoretical Analysis","author":"Luce","year":"1959"},{"issue":"2","key":"2024110620113607300_R21","doi-asserted-by":"publisher","first-page":"193","DOI":"10.2307\/2346567","article-title":"The analysis of permutations","volume":"24","author":"Plackett","year":"1975","journal-title":"Appl Stat"},{"issue":"1","key":"2024110620113607300_R22","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1016\/j.wem.2018.10.008","article-title":"Improvised hydration bladder air splint: a wilderness case report","volume":"30","author":"Hurt","year":"2019","journal-title":"Wilderness Environ Med"},{"issue":"4","key":"2024110620113607300_R23","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1016\/j.jamcollsurg.2016.07.009","article-title":"Dismounted complex blast injuries: a comprehensive review of the modern combat experience","volume":"223","author":"Cannon","year":"2016","journal-title":"J Am Coll Surg"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/189\/11-12\/2731\/60454113\/usae404.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/189\/11-12\/2731\/60454113\/usae404.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,6]],"date-time":"2024-11-06T20:11:55Z","timestamp":1730923915000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/189\/11-12\/2731\/7762781"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,20]]},"references-count":23,"journal-issue":{"issue":"11-12","published-online":{"date-parts":[[2024,9,20]]},"published-print":{"date-parts":[[2024,11,5]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usae404","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,11]]},"published":{"date-parts":[[2024,9,20]]}}}