It is now four years since coalition forces occupied Iraq and battle injuries are occurring continuously. The U.S. defence forces now have good documentation and analysis of resulting casualties.The evacuation system is very efficient and patients arrive for treatment very soon after injury. Soft tissue and skeletal injuries to the extremities occur in combination with multi-system injuries. This has required changes in management of extremity injuries. The principles have remained the same but the application is changing. There is more emphasis on initial treatment of the life and limb threatening features of extremity injuries and delaying definitive surgery until the general condition of the casualty is suitable. Debridement, external fixation and early amputation are the most frequent operations.The information from the U.S. is supported by data and is driving the evolution of management of war injuries. It is important that the ADF has access to this data and seeks opportunities for training general and orthopaedic surgeons in U.S. facilities.There are subtle differences in the clinical methods of U.S. and Australian orthopaedic surgeons which are partly cultural and partly training.These casualties arrive in large numbers with multiple system injuries and multiple extremity injuries very soon after wounding. The ADF could face a similar situation during major combat or after terrorist bombing in an Australian city. The injuries and workload are quite different to that of civilian practice or humanitarian assistance. Contact author: GPCAPT Greg Bruce, Defence Health Services, PO Box 1158, Hunters Hill, NSW, 2110Email: firstname.lastname@example.org
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