Musculoskeletal injury patterns associated with military operations

摘要

Musculoskeletal injury represents a significant attritional threat to troops on deployment and comprises a significant proportion of aeromedical evacuations from theatre. Whilst the incidence and outcome of battle injury (BI) is increasingly well understood, the picture regarding non-battle injury (NBI) is less clear despite the significantly higher incidence rate. This paper outlines and compares current evidence regarding the incidence, contributing factors and functional outcome of recent operational BI and NBI and highlights the need for further study into UK specific data and demographics. Introduction Op HERRICK represents the United Kingdom's (UK) stabilisation operation in Helmand Province, Afghanistan. This conflict has been intense, with British troops suffering 446 killed and 608 seriously wounded since 2001 (1). The deployment has coincided with a period of economic crisis and high national debt, resulting in increased pressure on military expenditure. The Strategic Defence Review of 2010 outlined the requirement to reduce the size of the Army from 102,000 to a total force of around 95,000, with the aim of increasing reliance on technology and reservists to replace Regular manpower to create a 'more mobile and more flexible' Army (2). However, a smaller pool of personnel increases the requirement to maintain higher proportions of fit, deploy able troops, making individual readiness a much higher priority (3-5). With reduced troop numbers, injury prevention combined with effective rehabilitation of those who suffer injury becomes a priority to maintain deployable numbers. Musculoskeletal injury in the form of Battle Injury (BI) or Non-Battle Injury (NBI) poses a significant risk to future operational effectiveness, as injury is a predictable outcome of warfare and causes the greatest reduction in combat readiness (6). Whilst the outcome of significant BI is increasing well understood, outcome of NBI is less so, despite being more common (7).