Page 78 - Journal of Special Operations Medicine - Spring 2017

selection function of the Web of Science to further limit increase in the number of publications from the 1990s
the topics of the publications. Reviews, editorials, and (n = 16) to the 2000s (n = 57). A slight decrease in the
proceedings papers were included in addition to original number of publications occurred from the 2000s to the
research. For convenience, all the selected publications 2010s, the most recent decade (which is an incomplete
are referred to as “articles.” decade). Of note, 50% (57 of 115) of the articles cited
were published in the decade from 2000 to 2009.
Abstracts for the 207 most-cited articles identified by
the search (or the full article when abstracts were not As shown in Table 4 and Figure 2, the largest numbers
available) were then reviewed by two combat-experi- of top-cited articles were primarily on the topics of
enced military orthopedic surgeons (J.F.K. and D.J.S.) comorbid vascular trauma (n = 28) and epidemiology
to ensure (1) their focus was on extremity and bone in- (n = 27), followed by orthopedic trauma (n = 24). These
jury secondary to combat-related trauma and (2) their three, collectively, were the topics of 69% of the top-
emphasis was primarily orthopedic and joint-based in cited articles.
content.
As shown in Table 5, the journals that published the
The 115 most frequently cited articles were then se- largest numbers of top-cited combat orthopedic articles
lected for further analysis. These top-cited articles were were Journal of Trauma–Injury Infection and Critical
then analyzed by overall number of citations, the top- Care (n = 33), followed by Military Medicine (n = 10)
cited article for each decade, number of top-cited ar- and Foot and Ankle Clinics (n = 5).
ticles by decade, primary study topic (i.e., resuscitation,
epidemiology, hemostasis, infection, vascular trauma, Discussion
neurotrauma, orthopedic trauma, prehospital, trauma
system, wound management, anesthesia), top-cited au- By identifying the top 115 combat orthopedic trauma
thor, and journal rank by number of top-cited articles. In articles, the present study identified the most impor-
addition, notable articles relating to combat orthopedic tant contributions to the field in the past seven decades.
trauma that were not identified through the search were These articles helped shape the direction of clinical re-
included for analysis as “missing articles.” Descriptive search, applied preclinical research, and basic science;
statistics were then performed by using SAS version 9.2 thus, they contributed to the evolution of orthopedic
(SAS Institute, https://www.sas.com). traumatology and care. These combat orthopedic arti-
cles also had an impact on the broader trauma literature
and advanced our understanding of the pathophysiol-
Results
ogy and mechanism of injury of trauma-induced ex-
The 115 most-cited articles and their publication infor- tremity and joint injury.
mation are listed in Table 1. The number of citations
for this group of articles ranged from 2 to 137 citations Top of the Top
per article. The most-cited article found in our original
search was by Owens et al. (“Characterization of ex- Historically, extremity injury has accounted for the vast
tremity wounds in Operation Iraqi Freedom and Opera- majority of battlefield injuries. The Owens et al. study
10
tion Enduring Freedom” ). investigated the most recent US armed conflicts in Iraq
10
and Afghanistan. The authors analyzed and classified
Table 2 lists seven additional articles that were deemed the types of extremity injuries and found that explosive
influential to the field by the surgeons who reviewed munitions accounted for 75% of the mechanisms of in-
them yet were missed in our original search. Among jury. They analyzed Joint Theater Trauma Registry data
the missing articles, the most-cited was that of Bellamy and analyzed the 1,281 US casualties who sustained
(“The causes of death in conventional land warfare: im- 3,575 extremity combat injuries. A majority (53%) of
plications for combat casualty research” ), with 331 injuries were penetrating soft-tissue wounds, and 26%
21
citations. were fractures. Of these 915 fractures, 758 (82%) were
open fractures. These 915 fractures were distributed
Table 3 shows the most-cited article per decade during evenly between the upper (461; 50%) and lower ex-
the past seven decades. The number of articles in the top tremities (454; 50%). 10
115 by decade (Figure 1) illustrates the recent exponen-
tial increase in combat-orthopedic articles cited during The second most-cited article, by Coupland and Kor-
the study period. The years of publication for the most- ver, provided important earlier insights gained by
22
cited articles found in our original search ranged from studying 757 victims of antipersonnel mines from 13
1968 to 2012. No top-cited articles were published in hospitals in Africa and Asia. This International Com-
the 1940s, 1950s, 1970s, and 1980s. There was a 256% mittee of the Red Cross study classified injury patterns

56 Journal of Special Operations Medicine Volume 17, Edition 1/Spring 2017