• W Brett Johnson, Antuione D Perry, Garrett Flores, Sarah N Pierrie, Joseph F Alderete, Paul Allen, Jonathan Wilson, David King, and W Lee Childers.
• Extremity Trauma and Amputation Center of Excellence, JBSA Ft. Sam Houston, TX 78234, USA.
• Mil Med. 2024 Nov 5; 189 (11-12): 273127382731-2738.

IntroductionIn prolonged care scenarios, where medical evacuations are significantly delayed, the treatment and transport of casualties with extremity musculoskeletal injuries will drain combat units' human resources. Developing enhanced splinting techniques to restore casualty mobility and function can alleviate this drain. To guide this development, a panel of tactical combat and wilderness medicine experts was assembled to determine which extremity musculoskeletal injuries had the greatest impact on unit capabilities, and the materials available for splinting these injuries.Information GatheringUnstructured consultations with panel members yielded preliminary lists of injuries and materials. These lists were consolidated and redistributed to panel members for final evaluation where they ranked the injuries based on frequency and human resource cost and assessed the accessibility of materials. Responses for the final evaluation were statistically analyzed using Wilcoxon rank-sum tests and Placket Luce models.Lessons LearnedAggregated responses indicated that panel members thought that knee and ankle ligamentous injuries and radial head fractures were the most frequently occurring injuries, although closed distal femoral fractures, below knee amputations, and open tibia fractures would require the most demand for injury care. Assessing the combined impact of frequency and human resource cost indicated that knee and ankle ligamentous injuries and closed tibia fractures had the greatest impact on unit readiness. Responses also indicated that a variety of materials would be available for applying or improvising splints.ConclusionAlthough the combined impact of knee and ankle ligamentous injuries were ranked the highest, limitations in relative rankings and the existence of effective low-cost treatments for these injuries suggest that greater gains in unit effectiveness would come from focusing on developing solutions for fractures with higher human resource cost, such as leg and arm fractures. This information can be used to develop enhanced splints that can preserve unit readiness in the field.Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2024. This work is written by (a) US Government employee(s) and is in the public domain in the US.

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