title: U.S. Military Experience From 2001 to 2010 With Extremity Fasciotomy in War Surgery.
abstract: After trauma, compartment syndrome of the extremities is a common, disabling, and-if managed suboptimally-lethal problem. Its treatment by surgical fasciotomy continues to be useful but controversial. The purpose of this survey is to measure survival and fasciotomy in a large trauma system to characterize trends and to determine if fasciotomy is associated with improved survival.
  
  
  
  We retrospectively surveyed data from a military trauma registry for U.S. casualties from 2001 to 2010. Casualties had extremity injury or extremity fasciotomy. We associated survival and fasciotomy.
  
  
  
  Of 17,166 casualties in the total study, 19% (3,313) had fasciotomy and 2.8% (481) had compartment syndrome. Annual fasciotomy rates started at 0% (2001) and rose to 26% (2010). For all casualties, the survival rate initially was high (100%) but decreased steadily until its nadir (96.4%) in 2005. Thereafter, it increased to make a V-shaped trend with reversal occurring after fielding two interventions within the trauma system specifically for casualties at risk for fasciotomy-tourniquet use and a fasciotomy education program.
  
  
  
  Over a decade of war, the survival rate of extremity injured casualties was associated with two trauma system interventions-tourniquet usage and a fasciotomy education program. The current example of measuring implementation of initiatives may be useful as a model for future attempted improvements in health care.
authors.affiliation: U.S. Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234-7767.
authors.forename: John F
authors.initials: JF
authors.lastname: Kragh
authors.affiliation: U.S. Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234-7767.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Dubick
authors.affiliation: U.S. Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234-7767.
authors.forename: James K
authors.initials: JK
authors.lastname: Aden
authors.affiliation: Z-Medica Corporation, 4 Fairfield Boulevard, Wallingford, CT 06492.
authors.forename: Anne L
authors.initials: AL
authors.lastname: McKeague
authors.affiliation: U.S. Army Medical Research and Materiel Command, Fort Detrick, MD 21702.
authors.forename: Todd E
authors.initials: TE
authors.lastname: Rasmussen
authors.affiliation: U.S. Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234-7767.
authors.forename: David G
authors.initials: DG
authors.lastname: Baer
authors.affiliation: Department of Surgery, San Antonio Military Medical Center, JBSA Fort Sam Houston, TX 78234.
authors.forename: Lorne H
authors.initials: LH
authors.lastname: Blackbourne
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D003161:Compartment Syndromes / Q000209:etiology / Q000517:prevention & control; D005121:Extremities / Q000293:injuries* / Q000503:physiopathology; D000071938:Fasciotomy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014111:Tourniquets / Q000706:statistics & numerical data; D014481:United States; D014857:Warfare; D014947:Wounds and Injuries / Q000150:complications / Q000209:etiology