Page 93 - JSOM Fall 2023

An Ongoing Series

Mobility Solutions After a Lower Extremity Fracture
and Applicability to Battlefield and Wilderness Medicine

Lee W. Childers, PhD *; Joseph F. Alderete, MD ; Travis D. Eliason, BS ;
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Stephen M. Goldman, PhD ; Daniel P. Nicolella, PhD ; Sarah N. Pierrie, MD ;
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Gerald E. Stark, PhD ; Nicholas M. Studer, MD, NRP ; Joseph C. Wenke, PhD ;
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Jonathan B. Wilson, DPT ; Christopher L. Dearth, PhD 11
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ABSTRACT
The potential for delayed evacuation of injured Servicemem- mobility, thus maximizing survivability until patient evacua-
bers from austere environments highlights the need to develop tion is feasible.
solutions that can stabilize a wound and enable mobility
during these prolonged casualty care (PCC) scenarios. Lower Keywords: Prolonged casualty care; combat fractures; lower
extremity fractures have traditionally been treated by immo- extremity; mobility; splinting; wilderness
bilization (splinting) followed by air evacuation – a paradigm
not practical in PCC scenarios. In the civilian sector, treatment
of extremity injuries sustained during remote recreational Introduction
activities have similar challenges, particularly when adverse
weather or terrain precludes early ground or air rescue. This Recent advances in body armor, combat casualty care (in-
review examines currently available fracture treatment solu- cluding prehospital care), and air transport have improved
tions to include splinting, orthotic devices, and biological in- warfighter survivability in recent conflicts. In the Global War
terventions and evaluates their feasibility: 1) for prolonged use on Terror, and later the Central Command Overseas Contin-
in austere environments and 2) to enable patient mobilization. gency Operations, an estimated three quarters of survivable
This review returned three common types of splints to include: injuries in American and British troops involved the extremi-
a simple box splint, pneumatic splints, and traction splints. ties. Among patients with fractures, up to 60% involved the
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None of these splinting techniques allowed for ambulation. lower extremities, in part due to the high proportion of inju-
However, fixed facility-based orthotic interventions that in- ries caused by buried or surface-level improvised explosives.
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clude weight-bearing features may be combined with common Analysis of recent conflicts fought in austere environments
splinting techniques to improve mobility. Biologically-focused such as Latin America and the Sahel identified similar injury
technologies to stabilize a long bone fracture are still in their patterns. As such, these combat-related extremity injuries
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infancy. Integrating design features across these technologies have constituted a high proportion of theater evacuations in
could generate advanced treatments which would enable recent conflicts. 4
*Correspondence to walter.l.childers.civ@health.mil
1 Dr Lee W. Childers is affiliated with DoD/VA Extremity Trauma and Amputation Center of Excellence and the Center for the Intrepid, De-
partment of Rehabilitation Medicine, Brooke Army Medical Center, both at JBSA Ft. Sam Houston, TX, and the Department of Rehabilitation
Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD. Dr Joseph F. Alderete is a physician affiliated with the Center
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for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Ft. Sam Houston, TX, and the U.S. Army Institute
of Surgical Research, Brooke Army Medical Center, JBSA Ft. Sam Houston, TX. Dr Daniel P. Nicolella and Travis D. Eliason are affiliated with
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the Musculoskeletal Biomechanics Section, Materials Engineering Department, Southwest Research Institute, San Antonio, TX. Dr Stephen M.
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Goldman is affiliated with DoD/VA Extremity Trauma and Amputation Center of Excellence, JBSA Ft. Sam Houston, TX, and the Department
of Surgery, Uniformed Services University of the Health Sciences – Walter Reed National Military Medical Center, Bethesda, MD. Dr Sarah N.
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Pierrie is a physician affiliated with the Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA
Ft. Sam Houston, TX, and the Department of Orthopedics and Rehabilitation, Brooke Army Medical Center, JBSA Ft. Sam Houston, TX.
7 Dr Gerald E. Stark is affiliated with 8Professional Clinical Services, Ottobock Healthcare, Austin, TX, the Department of Engineering Manage-
ment and Technology, University of Tennessee at Chattanooga, Chattanooga, TN, and Northwestern University Prosthetics and Orthotics Center,
Northwestern University, Chicago, IL. Dr Nicholas M. Studer is a physician affiliated with the U.S. Army Institute of Surgical Research, Brooke
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Army Medical Center, JBSA Ft. Sam Houston, TX. Dr Joseph C. Wenke is affiliated with the U.S. Army Institute of Surgical Research, Brooke
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Army Medical Center, JBSA Ft. Sam Houston, TX and the Shriners Children’s Texas, Galveston, TX. Mr. Jonathan B. Wilson is affiliated with
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the Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Ft. Sam Houston, TX, the Department
of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, the Henry M. Jackson Foundation for the
Advancement of Military Medicine, Bethesda, MD, and Alabama College of Osteopathic Medicine, Dothan, AL. Dr Christopher L. Dearth is
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affiliated with the DoD/VA Extremity Trauma and Amputation Center of Excellence, JBSA Ft. Sam Houston, TX and the Department of Surgery,
Uniformed Services University of the Health Sciences – Walter Reed National Military Medical Center, Bethesda, MD.
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