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  1. Article ; Online: Pure Superior Wall Acetabular Fracture: A Rare Posterior Wall Variant.

    Richards, John T / Overmann, Archie L / D'Alleyrand, Jean-Claude G

    JBJS case connector

    2021  Volume 11, Issue 4

    Abstract: Case: We present a case of a pure superior wall acetabular fracture in an US soldier, caused by a collapsing wall. Although Letournel and Judet classified this pattern as a rare variant of a posterior-superior wall acetabular fracture, it shares ... ...

    Abstract Case: We present a case of a pure superior wall acetabular fracture in an US soldier, caused by a collapsing wall. Although Letournel and Judet classified this pattern as a rare variant of a posterior-superior wall acetabular fracture, it shares features of several patterns and the treatment more closely follows that of the anterior-based elementary patterns.
    Conclusion: The mechanism, incidence, and long-term outcomes of this fracture remain unknown, but improved recognition and proper classification may help to guide treatment. This case highlights 1 patient with this unique pattern and outlines its management and short- to mid-term outcome.
    MeSH term(s) Acetabulum/diagnostic imaging ; Acetabulum/injuries ; Acetabulum/surgery ; Fracture Fixation, Internal ; Hip Fractures ; Humans ; Spinal Fractures
    Language English
    Publishing date 2021-11-17
    Publishing country United States
    Document type Case Reports ; Journal Article
    ISSN 2160-3251
    ISSN (online) 2160-3251
    DOI e21.00289
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  2. Article ; Online: The evolution of damage control orthopedics: current evidence and practical applications of early appropriate care.

    D'Alleyrand, Jean-Claude G / O'Toole, Robert V

    The Orthopedic clinics of North America

    2013  Volume 44, Issue 4, Page(s) 499–507

    Abstract: This article summarizes the evolution of literature and practice related to fracture care in polytrauma patients. Particular emphasis is given to the management of femoral shaft fractures and the concept of damage control in these complex patients. The ... ...

    Abstract This article summarizes the evolution of literature and practice related to fracture care in polytrauma patients. Particular emphasis is given to the management of femoral shaft fractures and the concept of damage control in these complex patients. The application of these guidelines in common clinical practice is also discussed.
    MeSH term(s) Fracture Fixation ; Fractures, Bone/surgery ; Fractures, Bone/therapy ; Humans ; Multiple Trauma/surgery ; Multiple Trauma/therapy ; Time Factors
    Language English
    Publishing date 2013-10
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 417389-2
    ISSN 1558-1373 ; 0030-5898
    ISSN (online) 1558-1373
    ISSN 0030-5898
    DOI 10.1016/j.ocl.2013.06.004
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  3. Article: Operative treatment of a complete rupture of the origination of the rectus femoris.

    Bottoni, Craig R / D'Alleyrand, Jean-Claude G

    Sports health

    2012  Volume 1, Issue 6, Page(s) 478–480

    Abstract: A 23-year-old male athlete reported both feeling and hearing a pop in his anterior thigh while sprinting. This was followed by immediate pain and an inability to walk. He had swelling and tenderness in his inguinal region. Radiographs were normal. An ... ...

    Abstract A 23-year-old male athlete reported both feeling and hearing a pop in his anterior thigh while sprinting. This was followed by immediate pain and an inability to walk. He had swelling and tenderness in his inguinal region. Radiographs were normal. An magnetic resonance imaging revealed a complete avulsion of the rectus femoris from its origin on the anterior inferior iliac spine. Following discussions of his treatment options, the patient chose to undergo operative management of the injury. A surgical repair was performed of the tendon of the direct head to the anterior inferior iliac spine through bone tunnels. He had a full recovery over the next 6 months and subsequently returned to unrestricted active military duty.
    Language English
    Publishing date 2012-06-29
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2508802-6
    ISSN 1941-0921 ; 1941-7381
    ISSN (online) 1941-0921
    ISSN 1941-7381
    DOI 10.1177/1941738109337777
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  4. Article ; Online: The management of embedded metal fragment patients and the role of chelation Therapy: A workshop of the Department of Veterans Affairs-Walter Reed National Medical Center.

    Gaitens, Joanna M / Potter, Benjamin K / D'Alleyrand, Jean-Claude G / Overmann, Archie L / Gochfeld, Michael / Smith, Donald R / Breyer, Richard / McDiarmid, Melissa A

    American journal of industrial medicine

    2020  Volume 63, Issue 5, Page(s) 381–393

    Abstract: Exposure to retained metal fragments from war-related injuries can result in increased systemic metal concentrations, thereby posing potential health risks to target organs far from the site of injury. Given the large number of veterans who have retained ...

    Abstract Exposure to retained metal fragments from war-related injuries can result in increased systemic metal concentrations, thereby posing potential health risks to target organs far from the site of injury. Given the large number of veterans who have retained fragments and the lack of clear guidance on how to medically manage these individuals, the Department of Veterans Affairs (VA) convened a meeting of chelation experts and clinicians who care for embedded fragment patients to discuss current practices and provide medical management guidance. Based on this group's clinical expertise and review of published literature, the evidence presented suggests that, at least in the case of lead fragments, short-term chelation therapy may be beneficial for embedded fragment patients experiencing acute symptoms associated with metal toxicity; however, in the absence of clinical symptoms or significantly elevated blood lead concentrations (greater than 80 µg/dL), chelation therapy may offer little to no benefit for individuals with retained fragments and pose greater risks due to remobilization of metals stored in bone and other soft tissues. The combination of periodic biomonitoring to assess metal body burden, longitudinal fragment imaging, and selective fragment removal when metal concentrations approach critical injury thresholds offers a more conservative management approach to caring for patients with embedded fragments.
    MeSH term(s) Chelation Therapy/methods ; Foreign Bodies/therapy ; Humans ; Metals/adverse effects ; Military Medicine/methods ; Military Personnel ; Occupational Exposure/adverse effects ; Occupational Injuries/therapy ; Treatment Outcome ; United States ; United States Department of Veterans Affairs ; War-Related Injuries/therapy
    Chemical Substances Metals
    Language English
    Publishing date 2020-03-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 604538-8
    ISSN 1097-0274 ; 0271-3586
    ISSN (online) 1097-0274
    ISSN 0271-3586
    DOI 10.1002/ajim.23098
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  5. Article ; Online: The last days: The medical response of United States and allied military teams during the Afghanistan Exodus.

    Bozzay, Joseph D / Murphy, Timothy P / Baird, Michael D / Dingle, Marvin E / Rokayak, Omar A / Renninger, Chris / Boomsma, Shawn E / Milam, Brian P / Horrell, Timothy J / Rittenhouse, Bradley A / McGlone, Patrick J / Kashtan, Harris W / Buzzelli, Mark / How, Remealle A / Lynch, Bruce A / Heyda, Lauren / Humphries, Ashley E / Jessie, Elliot M / Patel, Jigarkumar A /
    Hardin, Ronald / Nelson, Kenneth J / D'Alleyrand, Jean-Claude G / Bradley, Matthew J / Potter, Benjamin K / Gurney, Jennifer M

    The journal of trauma and acute care surgery

    2023  Volume 95, Issue 2S Suppl 1, Page(s) S13–S18

    Abstract: Objectives: The objective of this study is to describe the United States and allied military medical response during the withdrawal from Afghanistan.: Background: The military withdrawal from Afghanistan concluded with severe hostilities resulting in ...

    Abstract Objectives: The objective of this study is to describe the United States and allied military medical response during the withdrawal from Afghanistan.
    Background: The military withdrawal from Afghanistan concluded with severe hostilities resulting in numerous civilian and military casualties. The clinical care provided by coalition forces capitalized on decades of lessons learned and enabled unprecedented accomplishments.
    Methods: In this retrospective, observational analysis, casualty numbers, and operative information was collected and reported from military medical assets in Kabul, Afghanistan. The continuum of medical care and the trauma system, from the point of injury back to the United States was captured and described.
    Results: Prior to a large suicide bombing resulting in a mass casualty event, the international medical teams managed distinct 45 trauma incidents involving nearly 200 combat and non-combat civilian and military patients over the preceding 3 months. Military medical personnel treated 63 casualties from the Kabul airport suicide attack and performed 15 trauma operations. US air transport teams evacuated 37 patients within 15 hours of the attack.
    Conclusion: Lessons learned from the last 20 years of combat casualty care were successfully implemented during the culmination of the Afghanistan conflict. Ultimately, the effort, teamwork, and system adaptability exemplify not only the attitudes and character of service members who provide modern combat casualty care but also the paramount importance of the battlefield learning health care system. A continued posture to maintain military surgical preparedness in unique environments remain crucial as the US military prepares for the future.Retrospective observational analysis.
    Level of evidence: Therapeutic/Care Management; Level V.
    MeSH term(s) Humans ; United States ; Military Personnel ; Retrospective Studies ; Afghanistan ; Military Medicine/methods ; Mass Casualty Incidents ; Wounds and Injuries ; Afghan Campaign 2001-
    Language English
    Publishing date 2023-05-29
    Publishing country United States
    Document type Observational Study ; Journal Article
    ZDB-ID 2651070-4
    ISSN 2163-0763 ; 2163-0755
    ISSN (online) 2163-0763
    ISSN 2163-0755
    DOI 10.1097/TA.0000000000004062
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  6. Article: Extremity War Injuries VIII: sequelae of combat injuries.

    Andersen, Romney C / D'Alleyrand, Jean-Claude G / Swiontkowski, Marc F / Ficke, James R

    The Journal of the American Academy of Orthopaedic Surgeons

    2014  Volume 22, Issue 1, Page(s) 57–62

    Abstract: The 2013 Extremity War Injury symposium focused on the sequelae of combat-related injuries, including posttraumatic osteoarthritis, amputations, and infections. Much remains to be learned about posttraumatic arthritis, and there are few circumstances in ... ...

    Abstract The 2013 Extremity War Injury symposium focused on the sequelae of combat-related injuries, including posttraumatic osteoarthritis, amputations, and infections. Much remains to be learned about posttraumatic arthritis, and there are few circumstances in which a definitive arthroplasty should be performed in an acutely injured and open joint. Although the last decade has seen tremendous advances in the treatment of combat upper extremity injuries, many questions remain unanswered, and continued research focusing on improving reconstruction of large segmental defects remains critical. Discussion of infection centered on the need for novel methods to reduce the bacterial load following the initial débridement procedures. Novel methods of delivering antimicrobial therapy and anti-inflammatory medications directly to the wound were discussed as well as the need for near real-time assessment of bacterial and fungal burden and further means of prevention and treatment of biofilm formation and the importance of animal models to test therapies discussed. Moderators and lecturers of focus groups noted the continuing need for improved prehospital care in the management of junctional injuries, identified optimal strategies for both surgical repair and/or reconstruction of the ligaments in multiligamentous injuries, and noted the need to mitigate bone mineral density loss following amputation and/or limb salvage as well as the necessity of developing better methods of anticipating and managing heterotopic ossification.
    MeSH term(s) Amputation, Traumatic ; Artificial Limbs ; Blood Vessels/injuries ; Focus Groups ; Humans ; Ligaments, Articular/injuries ; Limb Salvage ; Military Medicine ; Military Personnel ; Treatment Outcome ; Upper Extremity/injuries ; Warfare ; Wounds and Injuries/surgery ; Wounds and Injuries/therapy
    Language English
    Publishing date 2014-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1200524-1
    ISSN 1940-5480 ; 1067-151X
    ISSN (online) 1940-5480
    ISSN 1067-151X
    DOI 10.5435/JAAOS-22-01-57
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  7. Article ; Online: The utilization of a suture bridge construct for tibiofibular instability during transtibial amputation without distal bridge synostosis creation.

    Lewandowski, Louis R / Tintle, Scott M / D'Alleyrand, Jean-Claude G / Potter, Benjamin K

    Journal of orthopaedic trauma

    2013  Volume 27, Issue 10, Page(s) e239–42

    Abstract: Symptomatic distal tibiofibular instability is a known complication of trauma-related transtibial amputations. Overt proximal tibiofibular dislocations, which are easily recognized on routine radiographs, may occur concurrently with the traumatic injury ... ...

    Abstract Symptomatic distal tibiofibular instability is a known complication of trauma-related transtibial amputations. Overt proximal tibiofibular dislocations, which are easily recognized on routine radiographs, may occur concurrently with the traumatic injury or amputation. More commonly, however, the proximal tibiofibular joint remains structurally intact in the presence of distal instability due to the loss of the distal syndesmotic structures and damage to the interosseous membrane, resulting in fibular angulation and distal tibiofibular diastasis. Some authors have espoused treating this instability with the creation of a distal tibiofibular bridge synostosis (the so-called Ertl procedure or modifications there of) to prevent potentially painful discordant motion and to minimize the prominence of the residual distal fibula. Recent studies, however, have suggested an increase in complication and reoperation rates in transtibial amputations that received a bridge synostosis compared with standard transtibial amputations. Additionally, although there are several described techniques for bridge synostosis creation, most are dependent on having sufficient remaining fibula to construct the bone bridge without unnecessary shortening of the tibia; however, sufficient residual fibula is not always available after traumatic and trauma-related amputations. We propose a technique utilizing a suture bridge to restore tibiofibular stability when performing transtibial amputations in patients with proximal tibiofibular dislocations or distal diastasis, avoiding the potential need for a distal bridge synostosis.
    MeSH term(s) Adolescent ; Amputation/adverse effects ; Amputation/methods ; Child ; Female ; Humans ; Joint Instability/etiology ; Joint Instability/prevention & control ; Joint Instability/surgery ; Knee Joint/diagnostic imaging ; Knee Joint/surgery ; Male ; Prosthesis Design ; Radiography ; Suture Anchors ; Suture Techniques/instrumentation ; Synostosis/etiology ; Synostosis/prevention & control ; Treatment Outcome ; Young Adult
    Language English
    Publishing date 2013-10
    Publishing country United States
    Document type Clinical Trial ; Journal Article
    ZDB-ID 639099-7
    ISSN 1531-2291 ; 0890-5339
    ISSN (online) 1531-2291
    ISSN 0890-5339
    DOI 10.1097/BOT.0b013e31828d2c67
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  8. Article: Extrapolation of battlefield resuscitative care to the civilian setting.

    D'Alleyrand, Jean-Claude G / Dutton, Richard P / Pollak, Andrew N

    Journal of surgical orthopaedic advances

    2010  Volume 19, Issue 1, Page(s) 62–69

    Abstract: Experiences in treating wartime casualties in Iraq and Afghanistan have already led to changes in civilian trauma care practices. While advances in the care of civilian musculoskeletal injuries are likely as a result of ongoing military basic and ... ...

    Abstract Experiences in treating wartime casualties in Iraq and Afghanistan have already led to changes in civilian trauma care practices. While advances in the care of civilian musculoskeletal injuries are likely as a result of ongoing military basic and clinical research, major advances in resuscitative care have already been realized. Early liberal use of tourniquets to control bleeding from combat-associated extremity trauma has led to decreased mortality. Military experience has demonstrated that use of temporary intravascular shunts is effective for mitigating ischemic injury from vascular trauma until definitive repair can be accomplished. Hemostatic dressings have improved the surgeon's hemorrhage control armamentarium. Clinical experience with hypotensive resuscitation has led to refinement and improvement in the technique. Use of recombinant factor VIIa has improved hemorrhage control in the context of brain injury and coagulopathy and increasing the ratio of plasma to red cells during early shock resuscitation has improved survival.
    MeSH term(s) Hemostatic Techniques ; Humans ; Iraq War, 2003-2011 ; Military Medicine/methods ; Resuscitation/methods ; Tourniquets ; Vascular Surgical Procedures
    Language English
    Publishing date 2010
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2189157-6
    ISSN 2158-3811 ; 1548-825X ; 1059-1052
    ISSN (online) 2158-3811
    ISSN 1548-825X ; 1059-1052
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  9. Article ; Online: Risk factors for decreased range of motion and poor outcomes in open periarticular elbow fractures.

    Dickens, Jonathan F / Wilson, Kevin W / Tintle, Scott M / Heckert, Reed / Gordon, Wade T / D'Alleyrand, Jean-Claude G / Potter, Benjamin K

    Injury

    2015  Volume 46, Issue 4, Page(s) 676–681

    Abstract: Introduction: The purpose of this study was to identify risk factors present at the time of injury that predict poor functional outcomes and heterotopic ossification (HO) in open periarticular elbow fractures.: Materials and methods: We performed a ... ...

    Abstract Introduction: The purpose of this study was to identify risk factors present at the time of injury that predict poor functional outcomes and heterotopic ossification (HO) in open periarticular elbow fractures.
    Materials and methods: We performed a retrospective review of 136 combat-related open elbow fractures from 2003 to 2010. Patient demographics, injury characteristics, treatment variables, and complications were recorded. Functional outcomes were analyzed to determine range of motion (ROM) and Mayo Elbow Performance Score (MEPS). Secondary outcome measures included the development of HO, return to duty, and revision operation.
    Results: At a median 2.7 years from injury the median MEPS was 67.8 (range 30-100) with an average ulnohumeral arc motion of 89°. Bipolar fractures, with periarticular fractures on both sides of the elbow and at least one side containing intra-articular extension, were independently associated with decreased ulnohumeral motion (p=0.02) and decreased MEPS (p<0.004). Additional independent risk factors for decreased ROM included more severe osseous comminution (p=0.001), and increased time to definitive fixation (p=0.03) and HO (p=0.02). More severe soft tissue injury (Gustilo and Anderson fracture type, p=0.02), peripheral nerve injury (p=0.04), and HO (p=0.03) were independently associated with decreased MEPS. HO developed in 65% (89/136) of extremities and was associated with more severe Orthopaedic Trauma Association (OTA) fracture type (p=0.01) and escalating Gustilo and Anderson fracture classification (p=0.049).
    Conclusions: In the largest series of open elbow fractures, we identified risk factors that portend a poor clinical outcome and decreased ROM. Bipolar elbow fractures, which have not previously been associated with worse results, are particularly prone to decreased ROM and worse outcomes.
    Level of evidence: Prognostic level IV.
    MeSH term(s) Adult ; Biomechanical Phenomena ; Blast Injuries/diagnostic imaging ; Blast Injuries/physiopathology ; Blast Injuries/surgery ; Elbow Joint/diagnostic imaging ; Elbow Joint/physiopathology ; Elbow Joint/surgery ; Forearm Injuries/diagnostic imaging ; Forearm Injuries/physiopathology ; Forearm Injuries/surgery ; Fracture Fixation, Internal ; Fractures, Comminuted/diagnostic imaging ; Fractures, Comminuted/pathology ; Fractures, Comminuted/surgery ; Fractures, Open/pathology ; Fractures, Open/surgery ; Humans ; Iraq War, 2003-2011 ; Male ; Military Personnel ; Ossification, Heterotopic/diagnostic imaging ; Ossification, Heterotopic/etiology ; Ossification, Heterotopic/physiopathology ; Prognosis ; Radiography ; Range of Motion, Articular ; Retrospective Studies ; Risk Factors ; Treatment Outcome ; United States
    Language English
    Publishing date 2015-04
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 218778-4
    ISSN 1879-0267 ; 0020-1383
    ISSN (online) 1879-0267
    ISSN 0020-1383
    DOI 10.1016/j.injury.2015.01.021
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  10. Article: Combat-related hemipelvectomy.

    D'Alleyrand, Jean-Claude G / Fleming, Mark / Gordon, Wade T / Andersen, Romney C / Potter, Benjamin K

    Journal of surgical orthopaedic advances

    2012  Volume 21, Issue 1, Page(s) 38–43

    Abstract: Traumatic and trauma-related hemipelvectomies are rare and severe life-threatening injuries. Rapid hemostasis, early aggressive resuscitation, amputation completion, and wound debridement are the mainstays of initial treatment. Second-look debridements ... ...

    Abstract Traumatic and trauma-related hemipelvectomies are rare and severe life-threatening injuries. Rapid hemostasis, early aggressive resuscitation, amputation completion, and wound debridement are the mainstays of initial treatment. Second-look debridements and delayed wound closure are mandatory. A multidisciplinary team is necessary in order to treat associated injuries as well assist with eventual rehabilitation. Adherence to specific treatment tenants outlined herein may minimize mortality and secondary morbidity, improving patient outcomes following these devastating injuries.
    MeSH term(s) Amputation, Traumatic/rehabilitation ; Amputation, Traumatic/surgery ; Artificial Limbs ; Blast Injuries/rehabilitation ; Blast Injuries/surgery ; Hemipelvectomy ; Humans ; Military Medicine ; Reconstructive Surgical Procedures
    Language English
    Publishing date 2012
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2189157-6
    ISSN 2158-3811 ; 1548-825X ; 1059-1052
    ISSN (online) 2158-3811
    ISSN 1548-825X ; 1059-1052
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