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orthopedic science has taken a greater degree of own- 3. Beebe G, DeBakey ME. Battle casualties: Incidence, mor-
ership and stewardship of out-of-hospital mortality for tality and logistic considerations. Springfield, IL: Charles C
extremity-trauma casualties. Thomas; 1952:165–205.
4. Hardaway RM. Viet Nam wound analysis. J Trauma. 1978;18:
635–643.
Limitations of This Citation Analysis 5. Islinger RB, Kuklo TR, McHale KA. A review of orthopaedic
injuries in three recent US military conflicts. Mil Med. 2000;
In 2006, a group of civilian and military subject matter 165:463–465.
experts identified research gaps in the care of combat- 6. Mabry RL, Holcomb JB, Baker AM, et al. United States
Army Rangers in Somalia: An analysis of combat casualties
related extremity injuries. The identified knowledge on an urban battlefield. J Trauma. 2000;49:515–528.
gaps included the timing of treatment, techniques for 7. McBride JT, Hunt MM, Hannon JP, et al. “Institute Report
debridement, antibiotic treatments, management of seg- #468: Report and medical analyses of personnel injury from
mental defects, and amputee care, among others. As Operation ‘Just Cause.’” San Francisco, CA: Letterman Army
28
Institute of Research; 1991.
a result, over the previous decade, funding opportuni- 8. Reister FA. Battle casualties and medical statistics: US Army
ties have focused on closing these gaps. Much of the experience in the Korean War. Washington, DC: The Surgeon
literature stemming from these funding opportunities General, Department of the Army; 1973.
will likely contribute significantly to the treatment of 9. Uhorchak JM, Rodkey WG, Hunt MM, et al. “Institute Re-
combat- related extremity injuries; however, our report port #469: Casualty Data Assessment Team Operation Desert
is limited by the fact that more recently published ar- Storm.” San Francisco, CA: Letterman Army Institute of Re-
search; 1992.
ticles have not had as much time to be cited as earlier 10. Owens BD, Kragh JF Jr, Macaitis J, et al. Characterization of
publications. Thus, there is an inherent bias in our find- extremity wounds in Operation Iraqi Freedom and Operation
ings toward older publications. However, top-cited Enduring Freedom. J Orthop Trauma. 2007;21:254–257.
articles from earlier periods and “missing articles” ap- 11. Owens BD, Kragh JF Jr, Wenke JC, et al. Combat wounds in
pear to represent “citation classics.” Review is needed Operation Iraqi Freedom and Operation Enduring Freedom.
J Trauma. 2008;64:295–299.
to appreciate the impact of these more recent articles 12. Masini BD, Waterman SM, Wenke JC, et al. Resource utiliza-
from the 2010s. In addition, citation analysis does not tion and disability outcome assessment of combat casualties
evaluate the quality of the studies included or attempt to from Operation Iraqi Freedom and Operation Enduring Free-
assess their usefulness and impact on clinical and surgi- dom. J Orthop Trauma. 2009;23:261–266.
cal practice. However, the number of citations is likely 13. Cross JD, Ficke JR, Hsu JR, et al. Battlefield orthopaedic in-
juries cause the majority of long-term disabilities. J Am Acad
related to a study’s impact in that clinical arena. Orthop Surg. 2011;19(suppl 1):S1–S7.
14. Stinner DJ, Burns T, Kirk K, et al. Return to duty rate of am-
Despite such limitations, our study provides an insight- putee soldiers in the current conflicts in Afghanistan and Iraq.
ful analysis of combat orthopedic trauma and extremity J Trauma. 2010;68:1476–1479.
injury publications and citations. It also identifies the 15. Cross J, Stinner DJ, Burns TC, et al. Skeletal Trauma Re-
search Consortium (STReC). Return to duty after type III
topics and areas of greatest interest in the past seven de- open tibia fracture. J Orthop Trauma. 2012;26:43–47.
cades. By identifying the most-cited articles per decade, 16. Hirsch JE. An index to quantify an individual’s scientific
even though not each decade had a top-cited article, this research output. Proc Natl Acad Sci. 2008;102:16560–
analysis illustrates the evolution of research on combat 16572.
orthopedic trauma, such as increased ownership regard- 17. Ollerton JE, Sugrue M. Citation classics in trauma. J Trauma.
2005;58:364–369.
ing prehospital patient survival and reconstruction of 18. O’Connor DJ, Gargiulo NJ III, Scher LA, et al. One hundred
complex injuries involving muscle. At the same time, vascular surgery citation “classics” from the surgical litera-
our findings shed light on topics such as debridement ture. J Vasc Surg. 2011;53:1150–1156.
and injury prevention as knowledge gaps that persist 19. Orman JA, Eastridge BJ, Baer DG, et al. The impact of 10
and could help guide future research efforts to aid the years of war on combat casualty research: a citation analysis.
J Trauma Acute Care Surg. 2012;73:S403–S408.
deploying combat surgeon. 20. Nam JJ, Chung KK, King BT, et al. Citation classics in the
burn literature during the past 55 years. J Burn Care Res.
2014;35:176–185.
Disclosures 21. Bellamy RF. The causes of death in conventional land war-
The authors have nothing to disclose. fare: implications for combat casualty care research. Mil Med.
1984;149:55–62.
22. Coupland RM, Korver A. Injuries from antipersonnel mines–
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