title: The nature and incidence of musculoskeletal combat wounds in Iraq and Afghanistan (2005-2009).
abstract: OBJECTIVE
  This investigation sought to describe orthopaedic wounds sustained by service members deployed to Iraq or Afghanistan from 2005 to 2009.
  
  
  METHODS
  Retrospective review of prospective data.
  
  
  METHODS
  : Joint Theater Trauma Registry (JTTR).
  
  
  METHODS
  The 6092 musculoskeletal casualties contained in the JTTR.
  
  
  METHODS
  The JTTR was queried to identify all personnel sustaining musculoskeletal injuries in the period 2005-2009. Demographic information, injury mechanism, and nature of wounds were determined for all individuals. Deployment data for all service members were obtained through the Defense Manpower Data Center and the incidence of orthopaedic injuries and wounding patterns was assessed.
  
  
  METHODS
  Pairwise comparisons were made to identify statistically significant differences in incidence, and significant associations, between injury mechanism and injuries/wounding patterns.
  
  
  RESULTS
  The JTTR contained data on 6092 musculoskeletal casualties with 17,177 wounds. Seventy-seven percent of all casualties sustained a musculoskeletal wound. The incidence of musculoskeletal combat casualties was 3.06 per 1000 deployed personnel per year, with fractures occurring in 3.41 per 1000 and soft-tissue wounds most commonly encountered (4.04 per 1000). Amputations represented 6% of all combat wounds. Most musculoskeletal wounds were caused by explosive blast (P < 0.001), as were nearly all traumatic amputations.
  
  
  CONCLUSIONS
  This study represents the most complete description of the scope of orthopaedic war trauma. It also presents injury-specific incidences that have not previously been described for musculoskeletal combat casualties. Musculoskeletal casualties may occur in 3 of every 1000 personnel deployed per year.
  
  
  METHODS
  Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX 79920, USA.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Belmont
authors.forename: Brendan J
authors.initials: BJ
authors.lastname: McCriskin
authors.forename: Mark S
authors.initials: MS
authors.lastname: Hsiao
authors.forename: Robert
authors.initials: R
authors.lastname: Burks
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Nelson
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Schoenfeld
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000673:Amputation, Traumatic / Q000453:epidemiology; D001753:Blast Injuries / Q000453:epidemiology*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D054542:Iraq War, 2003-2011; D004204:Joint Dislocations / Q000453:epidemiology; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data; D009141:Musculoskeletal System / Q000293:injuries; D012042:Registries; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000453:epidemiology*; D020196:Trauma, Nervous System / Q000453:epidemiology; D014948:Wounds, Gunshot / Q000453:epidemiology