Civilian and detainee orthopaedic surgical care at an Air Force theater hospital

This study is a retrospective analysis of the orthopaedic care rendered to Iraqi citizens, both military and civilian, and detainees in Balad, Iraq, at an Air Force theater hospital. Defining the scope of care for this patient group and emphasizing the differences in care provided for the endemic population in contrast to the rapidly air-evacuated Coalition injured combatant are the primary focus of the study. Approximately 50% of more than 1600 trauma/combat-related injury admissions to Air Force Theater Hospital in Balad, Iraq, from the period of September 2, 2005 through January 18, 2006, were Iraqi citizens and detainees. The care rendered to this population differed from the care given to a rapidly air-evacuated patient in that definitive care of all combat wounds, including fracture care and soft tissue management, was the responsibility of the deployed surgeons. Open reduction and internal fixation, definitive debridement, Wound VAC placement (Vacuum-Assisted Closure Device; KCI International, San Antonio, Tex), and final soft tissue management were performed at Air Force Theater Hospital. All patients were treated according to their injuries, including detainees, who received the same level of care as any other injured patient. This article will depict examples of the civilian and detainee orthopaedic care available and performed in a war zone and how that care differed from that rendered to a rapidly evacuated American combatant. Injured Coalition combatants received high-level damage control orthopaedic care and initial debridements, with external fixation as the single most common means of long-bone fracture stabilization. Civilians and detainees seen at Balad received the same high-level care and much, if not all, of their definitive care while at Air Force Theater Hospital. The care rendered to Iraqi citizens and detainees at an Air Force theater hospital is described, with multiple case examples that reflect a high level of definitive care offered in a war zone.