September 14, 2016
2 min read

Military service members have high rates of noncombat musculoskeletal injuries

Noncombat to combat injury casualties had a ratio between 2.2:1 and 3:1.

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Military service members experienced a greater than three-fold rate of noncombat musculoskeletal injuries compared with combat-related injuries, according to a recent literature review published in the Journal of the American Academy of Orthopaedic Surgeons.

“Wars in Afghanistan and Iraq have a combined casualty estimate that exceeds 59,000 service members,” Philip J. Belmont, MD, told Orthopedics Today.

He added, “Noncombat musculoskeletal injuries are endemic within military deployed service members and occur at a greater than three-fold rate compared to [combat] musculoskeletal injuries,” Belmont said. “Service members with musculoskeletal injuries, behavioral health conditions and low socioeconomic status are at an increased risk for inferior outcomes.”

Philip J. Belmont, MD
Philip J. Belmont

Combat vs noncombat injuries

To explore combat and noncombat orthopedic injuries experienced among military service members, Belmont and colleagues conducted several investigations to include a longitudinal analysis that followed a cohort of more than 4,000 soldiers deployed to combat and found increases in severe combat orthopedic injuries during the last decade, which included traumatic amputations and injuries to the spine.

Research has shown a decline in gunshot-related combat injuries, with nearly 75% of all injuries sustained in combat caused by explosive mechanisms and 40% of all musculoskeletal injuries comprised of fractures. The researchers noted personnel exposed to combat more frequently experienced injuries to the axial skeleton, while nearly 40% of service members killed had spinal trauma. Service members with combat-related extremity injuries required the longest average inpatient stay and were responsible for 64% of total inpatient resource utilization. Sixty-four percent of service members with combat-related bone and joint injuries were permanently disabled.

When looking at noncombat injuries, Belmont and colleagues found a ratio between 2.2:1 and 3:1, respectively, of disease and nonbattle casualties to combat casualties throughout the wars in Iraq and Afghanistan. Between October 2001 and December 2012, 80.5% of military service members who required air medical transport sustained noncombat injuries vs. 19.5% for those wounded in action, according to results. The researchers found service members were three-times more likely to sustain a noncombat musculoskeletal injury, with 48% of all musculoskeletal casualties resulting from noncombat musculoskeletal trauma.

The review also showed nearly five-times greater incidence rates than those in the civilian population of anterior cruciate ligament disruption and shoulder dislocation from noncombat injuries. Nineteen percent of service members who were able to complete combat tours required an orthopedic surgical consultation on return. In addition, 4% of the service members underwent an orthopedic surgical procedure of which more than 50% involved the knee or shoulder.

Future research

Belmont noted future research will continue “to examine the occupational and functional outcomes of common orthopedic surgical procedures among military service members, especially for the most frequent noncombat musculoskeletal injuries.”

“Of particular interest is the surgical treatment of common knee disorders, including osteoarthritis and post-traumatic osteoarthritis, which are among the leading sources of medical disability and subsequent military discharge among U.S. military service members,” he said. – by Casey Tingle

Disclosure: Belmont reports no relevant financial disclosures.