Page 77 - Journal of Special Operations Medicine - Spring 2017

The Highest-Impact Combat Orthopedic
and Extremity Injury Articles in the Past 70 Years

A Citation Analysis

Jason J. Nam, MD; Woo S. Do, MD; Daniel J. Stinner, MD;
Joseph C. Wenke, PhD; Jean A. Orman, ScD; John F. Kragh Jr, MD

ABSTRACT

The objective of this study was to identify the most-cited Research on combat-related extremity injuries has led to
peer-reviewed combat orthopedic and extremity injury an increased understanding of the significance of these
articles published during the past 70 years. Orthopedic injuries and informed improvements in care. These im-
trauma presents ongoing challenges to both US civil- provements have implications not only for the military
ian and military healthcare personnel. Improvements but also for civilians. One way to measure the impact
in combat trauma and extremity injury survival and of individual research articles is to count the number
quality of life are the result of advances in orthopedic of times an article is cited, which represents acknowl-
trauma research. The Web of Science (including Science edgment of the article in another author’s publication.
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Citation Index) was searched for the most cited articles Citation analyses have been published on trauma in
related to combat orthopedic trauma, published from general, vascular trauma, combat casualty care,
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1940 to 2013. The most-cited article was by Owens et and burns, but have not been reported for the combat
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al. (Journal of Orthopaedic Trauma, 2007; 137 cita- orthopedic literature.
tions). Between the 1990s and 2000s, there was a 256%
increase in the number of highly cited publications. A The purpose of this study was to identify and analyze
total of 69% of the articles were on the topics of comor- the 115 most-cited combat orthopedic trauma- and ex-
bid vascular trauma (25%), epidemiology (23%), or or- tremity injury–related articles in the peer-reviewed bio-
thopedic trauma (21%). This study identifies some of medical literature during the past 70 years.
the most important contributions to combat orthopedic
trauma and research and the areas of greatest scientific Methods
interest to the specialty during the past seven decades
and highlights key research that has contributed to the The Web of Science (including Science Citation Index;
evolution of modern combat orthopedic traumatology. http://login.webofknowledge.com) was queried on 9
April 2013 for articles relating to combat orthopedic
Keywords: combat; orthopedic; trauma; extremity injury trauma and extremity injury published from 1 January
1940 to 31 March 2013. The Web of Science, which
is produced by the Institute for Scientific Information,
provides Web access to the Science Citation Index,
Introduction
MEDLINE, and other citation indexes, which collec-
Healers in antiquity as well as military surgeons in tively index more than 12,000 journals worldwide, in-
1
modern combat have struggled to improve care for war cluding open-access journals. We searched for articles
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casualties with extremity wounds. From World War II to indexed by one or more of the following terms: ortho-
the conflict in Somalia, extremity injuries accounted for paedic trauma, orthopedic trauma, orthopedic injury,
58% to 88% of US combat wounds. In Iraq and Af- orthopaedic injury, extremity trauma, mangled extrem-
3–9
ghanistan, where extremity injuries accounted for 54% ity, limb salvage, traumatic amputation, bone trauma,
of injuries, severe orthopedic trauma from explosions extremity wounds, bone graft and trauma, or extrem-
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accounted for 78% of injuries, the highest proportion ity injury, with exclusions of cancer, sarcoma, tumor,
for explosions as a mechanism of injury recorded in any and oncology, and one or more terms relating to the
large-scale conflict. The severity of these injuries often military or war: World War II, Korean War, Vietnam
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translates into extended care in the intensive care unit, War, Operation Enduring Freedom, Operation Iraqi
rehabilitation, multiple reconstructive surgeries, and Freedom, OEF, OIF, overseas contingency operations,
long-term disability and can contribute to the inability Global War on Terrorism, Global War on Terror, mili-
of wounded Servicemembers to continue to serve. 12–15 tary, war, or combat. We also used the “subject area”

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