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J Am Acad Orthop Surg, Vol 15, No 10, October 2007, 588-589.
© 2007 the American Academy of Orthopaedic Surgeons

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Introduction Extremity War Injuries: Development of Clinical Treatment Principles

COL James R. Ficke, MD, MC, USA and Andrew N. Pollak, MD


The symposium Extremity War Injuries: State of the Art and Future Directions (EWI I) held in January 2006 was the first combined effort of the American Academy of Orthopaedic Surgeons (AAOS), the Orthopaedic Trauma Association (OTA), and the United States military to discuss orthopaedic injuries sustained during Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). That symposium resulted in a special issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), which featured detailed discussion of clinical challenges encountered and outlined a prioritized list of future research directions related to wound management, antibiotics and infection, management of segmental bone defects, stabilization of long bones, and amputee care.

A synopsis of the second symposium in the series is presented in the following article. This joint AAOS-OTA symposium held in January 2007, Extremity War Injuries: Development of Clinical Treatment Principles (EWI II), represented a continued collaboration with the military and aimed to promote development of evidence-based treatment guidelines for far-forward medical care of high-energy blast injuries.

The EWI II symposium was attended by notable Department of Defense and military representatives, including LT GEN James G. Roudebush, MD, US Air Force Surgeon General; David S. C. Chu, PhD, Under Secretary of Defense for Personnel and Readiness; David N. Tornberg, MD, MPH, Deputy Assistant Secretary of Defense for Clinical and Program Policy; COL Paul Cordts, MD, Director, Health Policy and Services, Office of the US Army Surgeon General; LTC James Keeney, MD, Orthopaedic Consultant to the Air Force Surgeon General; and CAPT Daniel Unger, MD, Orthopaedic Specialty Advisor to the US Navy Surgeon General.

The symposium was also attended by notable Congressional representatives, including Rep. Marsha Blackburn (R-TN), House Energy and Commerce Committee, and staff representation from the offices of Sen. Daniel K. Inouye (D-HI), Chair of the Defense Appropriations subcommittee, and Rep. Dutch Ruppersberger (D-MD), House Appropriations Committee.

Additionally, the symposium was attended by several federal and executive branch representatives, including Michael Weinrich, MD, Director, National Center for Medical Rehabilitation Research [NCMRR]/National Institute of Child Health and Human Development [NICHD]/National Institutes of Health [NIH]; James Panagis, MD, MPH, Director, Orthopaedic Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases [NIAMS]/NIH; Wilma Peterman Cross, MS, Senior Program Analyst, NIAMS; Rocky Tuan, PhD, Branch Chief, Cartilage Biology and Orthopaedics Branch, NIAMS/NIH; and Richard Schmidt, MD, Chief, Orthopaedic Surgery, Minneapolis Veterans Affairs Medical Center.

We would like to acknowledge the individuals, groups, and sponsors without whom the symposium would not have been possible. We would like to thank the EWI II session moderators for their time, dedication, and leadership: LTC Donald Gajewski, MD; COL Roman Hayda, MD; COL Donald Jenkins, MD; CDR Michael Mazurek, MD; MAJ Gregory Osgood, MD; COL Elisha Powell IV, MD; and CAPT Daniel Unger, MD.

We would also like to thank Denis R. Clohisy, MD, and the AAOS Research Development Committee; Joshua J. Jacobs, MD, and the AAOS Council on Research, Quality Assessment and Technology; Richard Kyle, MD, James Beaty, MD, E. Anthony Rankin, MD, and the AAOS Board of Directors; the EWI Steering Committee (LTC Romney C. Andersen, MD; COL Edward Arrington, MD, FACS; David G. Baer, PhD; Michael J. Bosse, MD [CAPT, USN, ret]; CAPT Dana C. Covey, MD; COL William C. Doukas, MD; LTC H. Michael Frisch, MD; COL Roman A. Hayda, MD; LTC James Keeney, MD; Richard F. Kyle, MD; LCDR Michael Mazurek, MD; Tracy L.C. Popey, MD; COL Mark W. Richardson, MD; MAJ Steven J. Svoboda, MD; CAPT Daniel V. Unger, MD; and Joseph C. Wenke, PhD); Stuart Weinstein, MD, and LTC Daniel White, MD, for initiating the EWI Symposium series; the AAOS Public Relations Department and Post Office Editorial for film footage of "Moving Pictures;" and AAOS staff leadership, including Christy M.P. Gilmour, Erin L. Ransford, Kristy Glass, David Lovett, Robert Jasak, Kathryn Pontzer, Kate Mevis, David Smith, Nancy Franzon, and Karen L. Hackett, FACHE, CAE.

The AAOS and the OTA would like to thank the Society of Military Orthopaedic Surgeons (SOMOS), the Orthopaedic Research Society (ORS), the AAOS Board of Specialty Societies (BOS/COMSS), and the United States Bone and Joint Decade for their support of the EWI II symposium. The AAOS and OTA acknowledge the following industry contributors and their representatives for their assistance in making the symposium and this article possible:

Last, we would like to recognize and express gratitude toward the brave military orthopaedic surgeons who served, are serving, or will serve troops and civilians overseas in OEF and OIF or other future challenges to our nation’s freedom. The AAOS and the OTA would like to remember COL Brian D. Allgood, MD, our esteemed colleague, who was killed while serving in Iraq on January 20, 2007. COL Allgood was a top medical officer and an AAOS fellow with a distinguished 20-year military service. He was the second American surgeon killed in action as part of Operation Iraqi Freedom.

COL James R. Ficke, MD, MC, USA

EWI II Symposium Co-Chair

Orthopaedic Consultant to the US Army Surgeon General

Chairman, Department of Orthopaedics and Rehabilitation Brooke Army Medical Center

Andrew N. Pollak, MD

EWI II Symposium Co-Chair

Chief, Orthopaedic Trauma, RAC Shock Trauma Center University of Maryland School of Medicine





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