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. 2012;20 Suppl 1(0 1):S64-9.
doi: 10.5435/JAAOS-20-08-S64.

Posttraumatic osteoarthritis caused by battlefield injuries: the primary source of disability in warriors

Jessica C Rivera  1 , Joseph C Wenke, Joseph A Buckwalter, James R Ficke, Anthony E Johnson
Affiliations

Posttraumatic osteoarthritis caused by battlefield injuries: the primary source of disability in warriors

Jessica C Rivera et al. J Am Acad Orthop Surg. 2012.

Abstract

The Army Physical Evaluation Board results for wounded warriors from a previously described cohort were reviewed to identify permanently disabling conditions and whether the conditions were preexisting or caused by battlefield injury. Arthritis was the most common unfitting condition in this cohort, with 94.4% of cases attributed to combat injury and only 5.6% attributed to preexisting conditions or documented in the health records prior to battle injury. The most common causes of injury that resulted in arthritis were intra-articular fractures secondary to explosions, traumatic arthrotomies resulting from fragment projectiles, and gunshot wounds. Arthritis was recognized as a disabling condition an average of 19 ± 10 months after injury. Research is needed to enhance prevention and management of joint injuries in order to minimize the disabling effects of joint degeneration in this young patient population.

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Figures

Figure 1
Figure 1
Pie charts demonstrating that, of 450 patients who underwent a US Army Physical Examination Board evaluation to determine fitness for duty or retention in military service, 70% were found to have an unfitting condition that involved at least one extremity. These soldiers are presumed to be otherwise fit for duty. Psych = psychiatric condition.
Figure 2
Figure 2
Of 1,566 combat-wounded warriors from a previously published cohort, complete records with US Army Physical Evaluation Board (PEB) findings of 450 warriors were available for review and analysis. a Warriors with osteoarthritis as an unfitting condition (out of 450).
Figure 3
Figure 3
Graphic representation of the number of injuries per body part in our cohort. Injuries to the spine and shoulder were the most common.
Figure 4
Figure 4
Graphic representation of the rate of occurrence of osteoarthritis (OA) by injured anatomic region. Although the knee was the third most commonly injured anatomic region in the cohort, injuries to the knee resulted in OA 100% of the time. In contrast, injuries to the spine, the most commonly injured anatomic region, resulted in OA only 31% of the time.
Figure 5
Figure 5
Graphic representation of the average disability rating per site of injury. The average disability rating varied greatly by affected body region, with the foot receiving the highest rating and the knee and spine the lowest.
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