ORTHOPEDIC SURGERY IN VIETNAM
MEDICAL DEPARTMENT, UNITEDSTATES ARMYSURGERY IN VIETNAMORTHOPEDIC SURGERYEditor for Orthopedic Surgery
Colonel WILLIAM E. BURKHALTER,MC USA (Ret.)
By
Colonel ANTHONY BALLARD, MC, USA (Ret.)
Colonel PAUL W. BROWN, MC, USA, (Ret.)
Colonel WILLIAM E. BURKHALTER, MC, USA, (Ret.)
Colonel WILLIAM W. EVERSMANN, Jr, MC, USA, (Ret.)
Colonel JOHN A. FEAGIN, Jr, MC, USA, (Ret.)
Colonel GERALD W. MAYFIELD, MC, USA, (Ret.)
Colonel GEORGE E. OMER, MC, USA, (Ret.)
OFFICE OF THE SURGEON GENERAL AND CENTER OF MILITARYHISTORY
UNITED STATES ARMY
WASHINGTON, D.C., 1994
MEDICAL DEPARTMENT, UNITEDSTATES ARMY
The volumes comprising the official history of theMedical Department of the UnitedStates Army in Vietnam are prepared by the U.S. Army Center of MilitaryHistory and publishedunder the direction of the Surgeon General and the Chief of MilitaryHistory. These volumes aredivided into two groups, (1) the professional, or clinical andtechnical, and (2) medically relatedsubjects. This is the third volume of the former group; the first twovolumes are entitled "SkinDiseases in Vietnam, 1965-72," and "General Medicine and InfectiousDiseases."
Contents
Chapter
1The Soldier and His Wound in Vietnam
(Colonel John A. Feagin, Jr., MC, USA(Ret.))
The Milieu
Care of the Wounded Soldier
Care of the Soldier's Wound
Wound Infection and Antibiotics
MEDCAP Activities
2Penetrating Injuries of the Thigh WithAssociated Femoral Fracture
(Colonel William E. Burkhalter, MC,USA (Ret.))
Practices During the Vietnam Conflict
Treatment in Japan
Treatment in CONUS--Ambulation in the Cast Brace
Lessons Learned
3Penetrating Wounds of the Leg With AssociatedFractures of theTibia
(Colonel William E. Burkhalter, MC,USA (Ret.))
Historical Background
Treatment in Vietnam
Treatment After Vietnam
Recommendations
4Wounds of the Hand
(Colonel William E. Burkhalter, MC,USA (Ret.))
Development of Army Hand Surgery
Conclusions
5Wounds of the Foot
(Colonel Anthony Ballard, MC, USA(Ret.))
Treatment Principles
Specific Injuries
Recommended Operative Approach to Deep Compartments of the WoundedFoot
Summary
6Wounds of Joints
(Colonel Anthony Ballard, MC, USA (Ret.))
Historical Background
Overall Policy in the Treatment of Joint Wounds
Wounds of the Knee
Wounds of the Hip
Wounds of the Shoulder
7Vietnam War Amputees
(Colonel Gerald W Mayfield, MC, USA(Ret.))
Wounds and Wounding Agents
Management of Patients With Amputations
Management of Amputations Classified by Anatomical Site
Special Prosthetic Considerations
Lessons Learned
8Peripheral Nerve Problems
(Colonel George E. Omer, Jr., MC, USA(Ret.), and Colonel William W.Eversmann, Jr., MC, USA (Ret.)
Initial Surgery
Spontaneous Recovery
Management of Painful Neuroma in Continuity and Causalgia
Surgical Techniques
Extremity Reconstruction
Long-Term Follow-up of Combat-Incurred Peripheral Nerve
Injuries at Fitzsimons Army Medical Center
Summation
9Rehabilitation of the Combat-Wounded Amputee
(Colonel Paul W. Brown, MC, USA (Ret.))
Historical Background
Evacuation Policies and the Patient in the Vietnam War
Care in CONUS Hospitals
Rehabilitation: The Challenge
Motivation and the Rehabilitation Program
Lessons Learned and Recommendations
10Epilogue: General Thoughts on the Managementof OrthopedicCasualties
(Colonel William E. Burkhalter, MC,USA (Ret.))
Lessons Learned and Unlearned
Communication and Consultants
Continuity of Care and Rehabilitation
Illustrations
Figure
1The MedEvac "Huey" helicopter
2Evacuation of a wounded soldier
3High-velocity gunshot wound of the humerus
4Examples of patient-care facilities
4Examples of patient-care facilities cont'd
5Elevation to allow circumferential extremitysurgical preparation
6Tobruk splint used with femoral fractures
7Ipsilateral femoral and tibial fracture withcontralateralbelow-knee amputation in continuous traction
8Cast brace to allow stabilization and use of limbmusculature
9Moderate soft tissue injuries with femoralfracture and bone loss
10Severe soft tissue injury with bone loss
10Severe soft tissue injury with bone loss cont'd
11Use of an air splint
12Example of poor debridement which resulted inbelow-kneeamputation
13Treatment of tibial shaft fracture with long-legand Delbet casts
14Open fracture with exposed bone andcontralateral above-kneeamputation
14Open fracture with exposed bone andcontralateral above -knee amputation cont'd
15Middle one-third tibia bone loss
15Middle one third tibia bone loss cont
16Blast injury to hand with skin and bone loss
16Blast injury to hand with skin and bone loss cont'd
16Blast injury to hand with skin and bone loss cont'd
17Through-and-through high-velocity wound of ahand with previousindex ray excision
17Through-and-through high-velocity wound of ahand with previous index ray excision cont'd
17Through-and-through high-velocity wound of ahand with previous index ray excision cont'd
18Multiple open fractures with skin loss
18Multiple open fractures with skin loss cont'd
18Multiple open fractures with skin loss cont'd
19Viable but unstable index finger following blastinjury
19Viable but unstable index finger followingblast injury cont'd
20Bone loss injury to first metacarpal withresultant adductioncontracture of the thumb
20Bone loss injury to first metacarpal withresultant adduction contracture of the thumb cont'd
20Bone loss injury to first metacarpal withresultant adduction contracture of the thumb cont'd
20Bone loss injury to first metacarpal withresultant adduction contracture of the thumb cont'd
21Severe explosive injury to the wrist with bone,tendon, and skinloss
21Severe explosive injury to the wrist with bone,tendon, and skin loss cont'd
21Severe explosive injury to the wrist with bone,tendon, and skin loss cont'd
22Necrosis of the forefoot following crush injury
23Medial plantar wound from bamboo stakepenetration into deepplantar compartments
24Skin incision for exploration of plantar footcompartments,avoiding primary weightbearing prominences
25Retracted laciniate ligament, exposing posteriortibial
26Shotgun wound of the ankle with destruction ofthe talus andfracture of the calcaneus
26Shotgun wound of the ankle with destruction ofthe talus and fracture of the calcaneus cont'd
27Longitudinal heel-splitting incision to debrideinfectedcalcaneus and plantar heel wounds
28Perforating gunshot wound of the heel
29Gunshot wound to the hindfoot with severe damageto the calcaneusand nerves and arteries of the heel pad
30Chopart amputation with common equivinorusdeformity of thehindfoot
31Loss of lateral rays, compatible with fair footfunction
32Loss of medial rays, resulting in poor footfunction
33Use of skin of toes 2-4 to resurface plantararea over metatarsalheads
34Transection of origins of abductor and flexordigitorum brevismuscles
35Willem's technique of active joint motion in thepresence of openwounds applied to the elbow
35Willem's technique of active joing motion inthe presence of open wounds applied to the elbow cont'd
36Treatment of infection following penetratinginjuries of the knee without significant fractures
36Treatment of infection following penetratinginjuries of the knee without significant fractures cont'd
37Saggital diagram of a knee in partial flexion,showing spacesthat sequester effusion and purulent material
38Arthrodesis of the shoulder without humeral head
39Continuous distal skin traction in openamputations
40Severe mid-tarsal gunshot wound converted toChopart followingdebridement
41Temporary plaster blow-knee prosthesis
42Use of elastomer foam insert, allowing earlyprosthetic training
43Bent-knee pylon, allowing early ambulation
44X-ray evaluation to allow improved prosthesisfabrication
45Method of managing painful neuroma in continuityand causalgia
45Method of managing painful neuroma incontinuity and causalgia cont'd
46Surgical scar following surgical sympathectomy
47Epineurial repair by freeing and transposing theulnar nerve
48Fascicular bundle nerve grafts of ulnar nerve
49Extensor indicis proprius transfer
50Tendon transfer of long or ring flexor digitorumsuperficialis
51Application of von Frey monofilament to a digit
52Transfer of double neurovascular cutaneousisland fromring-little web space to thumb-index web space
53Amputee ski program, Arapahoe Basin, Colorado
54Three-track skiers
55Bilateral above-knee amputee skier with "stubby"prostheses
56Bilateral above-knee amputee with improvisedswim fins
57Triple amputee in riding saddle
58Amputees at a gallop
Tables
Number
1 Mechanism of injury of 300 patients with fractured femurs
2 Location and type of femoral fracture
3 Amputations during first hospitalization for midfoot metatarsal injury, Fitzsimons General Hospital, 1966-70
4 Amputations or revisions at subsequent hospitalization for midfoot or metatarsal injury, Fitzsimons General Hospital, 1966-70
5 Results after first hospitalization, open injuries of the foot, Brooke Army Medical Center, 1966-69
6 Final disposition of patients with knee wounds
7 Influence of intra-articular fractures on final results
8 Interval between injury and spontaneous recovery in gunshot wounds
9 Time scale in months for spontaneous recovery in gunshot wounds
10 Summary of upper extermity nerve injuries at Brooke Army Medical Center
11 Causalgia: Nerves involved (1966-70) during Vietnam War
12 Causalgia: Time of onset of symptoms (1969-70) during Vietnam War
13 Causalgia: Causative agent (1966-78) during Vietnam War
14 Causalgia: Results of treatment (1966-70) during Vietnam War
15 Vietnam neurorrhaphy related to etiology and level of injury
16 Vietnam neurorrhaphy secondary suture-specific nerves
17 Vietnam cases with external neurolysis
18 Autogenous grafts of major nerves-Vietnam War
19 Early tendon transfers as internal splints
20 Median nerve palsy
21 Radial nerve palsy
22 Ulnar nerve palsy
23 Combined low median-low ulnar palsy
24 Combined high median-high ulnar palsy
25 Combined high median-radial palsy
26 Combined high ulnar-radial
