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  • Navy Medicine Researchers Find Risk of Delayed Amputation Highest in Combat-Related Foot Fractures

    KISSIMMEE, Florida – During the Military Health System Research Symposium (MHSRS) Aug. 16, Navy Medicine researchers shared findings from a recent study that examined the odds of delayed amputation after lower limb trauma sustained during combat.

            Dr. Susan Eskridge presents research about delayed amputation at MHSRS 2016.

    During Operation Iraqi Freedom and Operation Enduring Freedom, an estimated 50 percent of combat injuries involved limbs. To address this issue, Navy Medicine researchers conducted the study, “The Association of Specific Serious Lower Extremity Injuries with Delayed Amputation,” to help direct early medical care and improve health outcomes for warfighters by understanding which specific injuries to the limbs may lead to delayed amputation. In these analyses, delayed amputation was defined as a surgical removal of a limb that occurs more than 24 hours after the time of injury.

    The study, which was led by scientists at the Naval Health Research Center (NHRC), found that combat-related fractures of the calcaneus (heel bone), talus (ankle bone), and navicular (a bone at the top of the foot where the foot and ankle meet) had the highest odds of delayed amputation. Additionally, researchers found open fractures were more likely than closed fractures to lead to amputations.

    Researchers analyzed data from nearly 3,000 service members with at least one lower extremity, combat-related injury from 2002 to 2015. The data was pulled from the Expeditionary Medical Encounter Database (EMED), a high-quality data repository that was developed by scientists at NHRC and provides accurate injury and clinical treatment data for casualties from point of injury to definitive care and rehabilitation.

    “The research team, led by Susan Eskridge, Ph.D., examined the percentage of specific, acute injuries (fractures, nerve, and vessel injuries) and the percentage of delayed amputations with each of these injuries,” said Michael Galarneau, director for operational readiness at NHRC. “Using this information, the team could examine the odds of delayed amputation with each injury.”

    According to Galarneau, future research will examine other injuries and complications in relation to current findings. Additional studies will investigate other outcomes in this population, with the ultimate outcome in this line of research being the identification of factors that can affect quality of life.

    “By knowing more about the types of injuries that lead to adverse health outcomes for service members, such as delayed amputation, we can provide military and health care leaders with evidence-based knowledge to support decision-making that will lead to better medical treatments or improved personal protective gear,” said Galarneau. “Our goal is to prevent or reduce injuries to warfighters and improve their health outcomes.”

    Navy Medicine's research and development laboratories engage in a broad spectrum of activity from basic laboratory science to field studies at sites in remote areas of the world and in operational environments. Research topics include infectious diseases; biological warfare detection and defense; combat casualty care; environment health concerns; bone marrow research and registry; aerospace and undersea medicine; medical modeling, simulation and operational mission support; and epidemiology and behavioral sciences. The capabilities and global reach reflect the broad mission of Navy Medicine's Research and Development Enterprise.​

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