The Annual Meeting of SOMOS was held in San Antonio, Texas, in mid-December. The first lecture by Michael Bosse, a Gulf War veteran, focused on rethinking orthopaedic trauma priorities, with potential implications for both military planners and orthopaedic surgeons. The use of modem technology in the modem conflict environment and the requirement for very basic Orthopaedic care in the forward area (e.g. plaster casting), were addressed.
The following papers examined the use of arthroscopy in the deployed environment, and its ability to maintain effective troops on a mission, and the forward surgical stabilisation of penetrating lower extremity fractures, with a comparison of circular casting with external fixation. These were not mutually exclusive choices but simplicity was not to be forgotten. The requirement of responsible mission creep in Third World deployments was emphasised, noting that a balance needs to be found and appropriate parameters and guidelines identified.
The afternoon symposium on “Military Operations Other Than War”, including a contribution by LTCOL Steve Rudski, on secondment to the Brooke Army Medical Center, demonstrated the difficulties associated with these missions.
An innovative series of papers on the external fixator pin coating were presented. These noted the effectiveness of chlorhexidine, enhanced by combining with a hydroxyapatite coat, in buying time for an external fixator applied for transport purposes while allowing for further reconstructive surgery, such as intramedullary nailing, being performed at a later date. A paper on a cleanser for petroleum contaminated tissue was presented. This study had been initiated as a result of the release of oil during the Persian Gulf War and its potential contamination of combat wounds.
A segment on the treatment of knee cartilage injuries highlighted the recent work utilising autologising chondrocyte implantation, with a heated debate regarding its efficacy in returning serving members to full duty. The final morning was a cadaveric workshop on anterior cruciate reconstructive surgery.
In summary, the meeting demonstrated a broad range of civilian orthopaedics as well as injuries associated with serving members. Emphasis was placed on war surgery and the meeting reflected the mix of full and part-time Orthopaedic surgeons involved in all the services of the United States, with small contributions from British and Australian presenters.
