Epidemiology of combat wounds in Operation Iraqi Freedom and Operation Enduring Freedom: orthopaedic burden of disease.

The United States forces in Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) are primarily engaged in counterinsurgency operations within an irregular war. The US combat medical experience has reported new injury patterns secondary to the enemy's reliance on explosive mechanisms, particularly improvised explosive devices (IEDs), and the widespread use of individual and vehicular body armor. Musculoskeletal extremity injuries have been reported to comprise approximately 50% of all combat wounds for OIF/OEF. Utilization of individual body armor has dramatically reduced thoracic injuries and has decreased the lethality of gunshot wounds, as measured by the percent killed in action, which in conflicts prior to OIF/OEF was estimated at 33% but is now 4.6%. Explosive mechanisms of injury, with IEDs being the most common, account for over 75% of all combat casualties. The lethality of IEDs coupled with the protection of the thorax and abdomen provided by individual body armor has resulted in increasingly severe orthopaedic injuries. Collection and careful examination of orthopaedic combat casualties will allow for improved military personnel protective measures and treatment of injured soldiers.