title: Spinal Stabilization Using Orthopedic Extremity Instrumentation Sets During Operation Enduring Freedom-Afghanistan.
abstract: BACKGROUND
  The Role III, Multinational Medical Unit at Kandahar Air Field, Afghanistan, was established to provide combat casualty care in theater for International Security Assistance Forces, Afghanistan National Security Forces, and local nationals during Operation Enduring Freedom-Afghanistan. The authors describe their experience of treating unstable lumbar spine fractures with orthopedic extremity instrumentation sets from January 2007 to January 2008 and November 2010 to May 2011.
  
  
  METHODS
  During the study periods, 15 patients comprising Afghanistan National Security Forces and local nationals presented to the medical facility for treatment of unstable lumbar spine fractures. The patients underwent surgery for either anterior corpectomy and instrumented fusion (n = 5) or posterior instrumented fusion (n = 10). Because of periodic scarcity of spinal instrumentation sets, orthopedic extremity instrumentation sets were used (Synthes Large Fragment LCP Instrument and Implant Set) for spinal stabilization.
  
  
  RESULTS
  Immediate postoperative standing and sitting plain radiographs demonstrated no evidence of fracture progression or immediate hardware failure. One patient was seen in follow-up at 4 weeks and demonstrated construct stability on follow-up radiographs.
  
  
  CONCLUSIONS
  In the combat environment with sparse resources, unstable spine fractures may potentially be treated using instrumentation not specifically designed for spinal implantation. This is an off-label use, and the authors do not recommend the use of these techniques as standard treatment in most medical environments.
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Vijay M
authors.initials: VM
authors.lastname: Ravindra
authors.affiliation: Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Wallace
authors.affiliation: Department of Orthopedic Surgery, Detroit Receiving Hospital, Detroit, Michigan, USA.
authors.forename: Rahul
authors.initials: R
authors.lastname: Vaidya
authors.affiliation: Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.
authors.forename: W Christopher
authors.initials: WC
authors.lastname: Fox
authors.affiliation: Department of Neurosurgery, Naval Medical Center San Diego, San Diego, California, USA.
authors.forename: Arnett R
authors.initials: AR
authors.lastname: Klugh
authors.affiliation: Department of Orthopedic Surgery, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Puskas
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA. Electronic address: neuropub@hsc.utah.edu.
authors.forename: Min S
authors.initials: MS
authors.lastname: Park
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D001860:Bone Plates; D001863:Bone Screws; D002648:Child; D002675:Child, Preschool; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation*; D013904:Thoracic Vertebrae / Q000293:injuries*; D055815:Young Adult
keywords: Fracture; Hardware; Lumbar; Orthopedic extremity instrumentation set; Spine