Optimization of outcomes following limb salvage of combat-related lower extremity trauma

PhD by Published Work Study 1 Temporary External Fixation Is Safe in a Combat Environment. Possley DR, Burns TC, Stinner DJ, Murray CK, Wenke JC, Hsu JR, Skeletal Trauma Research Consortium. J Trauma 2010;69:S135-S139. Study 2 Outcomes of Internal Fixation in a Combat Environment. Stinner DJ, Keeney JA, Hsu JR, Rush JK, Cho MS, Wenke JC, Ficke JR, Skeletal Trauma Research Consortium. J of Surgical Orthopaedic Advances 2010;19(1):49-53. Study 3 (Appendix 3) Return to Duty Rate of Amputee Soldiers in the Current Conflicts in Afghanistan and Iraq. Stinner DJ, Burns TC, Kirk KL, Ficke JR. J Trauma 2010;68:1476-1479. Study 4 Prevalence of Late Amputations during the Current Conflicts in Afghanistan and Iraq. Stinner DJ, Burns TC, Kirk KL, Scoville CR, Ficke JR, Hsu JR, Late Amputation Study Team. Mil Med 2010;175(12):1027-1029. Study 5 Descriptive Characteristics and Amputation Rates With Use of Intrepid Dynamic Exoskeleton Orthosis. Hill O, Bulathsinhala L, Eskridge SL, Quinn K, Stinner DJ. Military Medicine 2016;181(S4):77-80. Study 6 Bedigrew KM, Patzkowski JC, Wilken JM, Owens JG, Blanck RV, Stinner DJ, Kirk KL, Hsu JR. Can an Integrated Orthotic and Rehabilitation Program Decrease Pain and Improve Function After Lower Extremity Trauma. Clin Orthop Relat Res 2014;472:3017-3025. Study 7 Stinner DJ, Wenke JC, Ficke JR, Gordon W, Toledano J, Carlini A, Scharfstein DO, MacKenzie EJ, Bosse MJ, Hsu JR. Military and Civilian Collaboration: The Power of Numbers. Mil Med 2017;182(3/4):10-17

Soil Management Regimes for Plant Health Care and Integrated Pest Management Programs in Ornamental Landscapes

Author Institution (Herms and Stinner): Department of Entomology, The Ohio State University; Author Institution (Hoitink): Department of Plant Pathology, The Ohio State University; Author Institution (Rose): Department of Horticulture and Crop Science, The Ohio State Universit

Technology as 'Applied Science': a Serious Misconception that Reinforces Distorted and Impoverished Views of Science

The current consideration of technology as 'applied science', this is to say, as something that comes 'after' science, justifies the lack of attention paid to technology in science education. In our paper we question this simplistic view of the science-technology relationship, historically rooted in the unequal appreciation of intellectual and manual work, and we try to show how the absence of the technological dimension in science education contributes to a na¿ ve and distorted view of science which deeply affects the necessary scientific and technological literacy of all citizens

Teaching of Energy Issues: A debate proposal for a GLobal Reorientation

The growing awareness of serious difficulties in the learning of energy issues has produced a great deal of research, most of which is focused on specific conceptual aspects. In our opinion, the difficulties pointed out in the literature are interrelated and connected to other aspects (conceptual as well as procedural and axiological), which are not sufficiently taken into account in previous research. This paper aims to carry out a global analysis in order to avoid the more limited approaches that deal only with individual aspects. From this global analysis we have outlined 24 propositions that are put forward for debate to lay the foundations for a profound reorientation of the teaching of energy topics in upper high school courses, in order to facilitate a better scientific understanding of these topics, avoid many students' misconceptions and enhance awareness of the current situation of planetary emergency

Correction to: Cluster identification, selection, and description in Cluster randomized crossover trials: the PREP-IT trials

An amendment to this paper has been published and can be accessed via the original article

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Military and Civilian Collaboration: The Power of Numbers

The purpose of this study was to compare the number and types of extremity injuries treated at civilian trauma centers (CIV CENs) versus military treatment facilities (MTFs) participating in the Major Extremity Trauma Research Consortium (METRC) and to investigate the potential benefits of a clinical research network that includes both civilian trauma centers and MTFs. Two analyses were performed. First, registry data collected on all surgically treated fractures at four core MTFs and 21 CIV CENs over one year were compared. Second, actual numbers and distribution of patients by type of injury enrolled in three METRC studies were compared. While MTFs demonstrated higher percentages of severe injuries including open fractures, traumatic amputations, vascular injuries, contamination, and injuries with bone, muscle, and skin loss when compared to CIV CENS, the CIV CENs treated a substantially higher number and, more importantly, enrolled patients in almost all categories. Comparison of service members to civilians was challenged by several differences between the two patient populations including mechanism of injury, the medical care environment, and confounding factors such as age, social setting and co-morbidities. Despite these limitations, in times without active military conflict, clinical trials will likely rely on civilian trauma centers for patient enrollment; only when numbers are pooled across a large number of centers can requisite sample sizes be met. These data demonstrate the benefits of maintaining a military-civilian partnership to address the major gaps in research defined by the Military

Osteomyelitis Risk Factors Related to Combat Trauma Open Femur Fractures: A Case-Control Analysis

OBJECTIVES: To identify the risk factors for osteomyelitis development in US military personnel with combat-related, open femur fractures? DESIGN: Retrospective observational case-control study. SETTING: US military regional hospital in Germany and tertiary care hospitals in United States (2003-2009). PATIENTS/PARTICIPANTS: One hundred three patients with open femur fractures who met diagnostic osteomyelitis criteria (medical record review verification) were classified as cases. Sixty-four patients with open femur fractures who did not meet osteomyelitis diagnostic criteria were included as controls. MAIN OUTCOME MEASUREMENTS: The main outcome measurements were multivariable odds ratios (ORs) and 95% confidence interval (CI). RESULTS: Among patients with surgical implants, osteomyelitis cases had significantly longer time to definitive orthopaedic surgery compared with controls (median: 21 vs. 13 days). Independent predictors for osteomyelitis risk were Gustilo-Anderson classification (transfemoral amputation OR: 19.3; CI: 3.0-123.0) and Orthopaedic Trauma Association Open Fracture Classification for muscle loss (OR: 5.7; CI: 1.3-25.1) and dead muscle (OR: 32.9; CI: 5.4-199.1). Being injured between 2003 and 2006, antibiotic bead use, and foreign body plus implant(s) at fracture site were also risk factors. CONCLUSIONS: Patients with open femur fractures resulting in significant muscle damage have the highest osteomyelitis risk. Foreign body contamination was only significant when an implant was present. Increased risk with antibiotic bead use is likely a surrogate for clinical suspicion of contamination with complex wounds. The timeframe association is likely due to changing trauma system patterns around 2006-2007 (eg, increased negative pressure wound therapy, reduced high-pressure irrigation, decreased crystalloid use, and delayed definitive internal fixations). LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence