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THE UNITED STATES ARMY MEDICAL DEPARTMENT OURNAL July–December 2018

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THE UNITED STATES ARMY MEDICAL DEPARTMENT OURNAL July–December 2018 THE UNITED STATES ARMY MEDICAL DEPARTMENT OURNAL July–December 2018 Infection Precedes Heterotopic Ossification in Combat Wounded . 1 Jessica K Juarez, MS; Mary Jo Pugh, PhD; Joseph C Wenke, PhD; Jessica C Rivera, MD Injury Mechanisms, Activities, and Limited Work Days in US Army Infantry Units . 6 Michelle Canham-Chervak, PhD, MPH; Catherine Rappole, MPH; et al RiskJ Factors for Sprains and Strains Among Physically Active Young Men: A US Army Study . 14 Robyn C. Martin, MPH; Tyson Grier, MS; Michelle Canham-Chervak, PhD, MPH; et al The Etiology of Injuries in US Army Initial Entry Training . 22 Veronique D. Hauschild, MPH; Terrence Lee, PhD; Stephen Barnes, MPH; et al Human Papillomavirus Incidence and Sexually Transmitted Coinfections Among US Military Recruits (2009-2015) . 30 COL Paul O. Kwon,USA; Jenny Lay, MPH; David Hrncir, MD, MPH; Lynn Levin, PhD, MPH Evaluation of NU-FlexSIV Socket Performance for Military Service Members with Transfemoral Amputation . 38 Starr E. Brown, MS; Elizabeth Russell Esposito, PhD; Jason M. Wilken, PT, PhD; Stefania Fatone, PhD Motivational Guest Speaker Presentation as an Anti-Stigma Intervention for US Army Soldiers . 48 MAJ Rohul Amin, USA; CPT Sarah C. McLeroy, USA; MAJ Victor M. Johnson, USA Lessons Learned: Military Screening for Posttraumatic Stress Disorder . 54 Tiffany L. Schweitzer, PhD, MHA; Earla J. White, PhD, MEd; Ronald P. Hudak, JD, PhD Military Medicine Implements In-home Virtual Health in Europe . 59 Steven M. Cain, MPAS; LTC Robert J. Cornfeld, USA; COL Kirk H. Waibel, USA; et al Sexual Dimorphic Features Associated with Femoroacetabular Impingement . 65 CPT Victoria B Okpala, USA; CPT David J Tennent, USA; et al Case Report: Unilateral Paresis of the Abdominal Wall with Associated Thoraco-Lumbar Pain . 74 Maria Francisca Elgueta, MD; Nina Nan Wang, MD; Gaurav Gupta, MD; LCol Markus Besemann, MD Application of High Energy Extracorporeal Shockwave Therapy on Musculoskeletal Conditions in US Military Medical Facilities . 76 CPT Sally Corey, USA; LTC Terry Mueller, USA; COL (Ret) John Bojescul, USA; Craig Cameron, DO Animal Derived Thiol Induced Work Exacerbated Asthma: A Brief Case Report of a Unique Workplace Hazard . 84 LTC John W. Downs, USA; Joshua M. Renshaw, MS Institution of Military Working Dog Physical Profile Record to Clarify This Article Retracted Medical Readiness Category Status . By Publisher . 87 CPT Sean P. Curry, USA; CPT Jeremy W. Lewis, USA February 14, 2019 A Professional Publication THE UNITED STATES ARMY of the AMEDD Community MEDICAL DEPARTMENT OURNAL Online issues of the AMEDD Journal are available at http://www.cs.amedd.army.mil/amedd_journal.aspx July – December 2018 US Army Health Readiness Center of Excellence PB 8-18-7/8/9/10/11/12 LTG JNadja Y. West The Surgeon General Commander, US Army Medical Command MG Patrick D. Sargent Commander US Army Medical Department Center and School US Army Health Readiness Center of Excellence Edward A. Lindeke Director By Order of the Secretary of the Army: Borden Institute Official: Richard Burton Editor GERALD B. O’KEEFE Mark A. Milley US Army Medical Department Journal Administrative Assistant to the General, United States Army COL (Ret) Mustapha Debboun, PhD, BCE Secretary of the Army Chief of Staff Chairman Emeritus, Executive Review Board DISTRIBUTION: Special 1826906 The Army Medical Department Journal [ISSN 1524-0436] is published high quality, print medium to encourage dialogue concerning healthcare quarterly for The Surgeon General by the Borden Institute, USAMEDDC&S, DOTAA initiatives. 3630 Stanley RD Attn: AMEDD JRNL, JBSA Fort Sam Houston, TX 78234-6100. Appearance or use of a commercial product name in an article published Articles published in The Army Medical Department Journal are listed and in the AMEDD Journal does not imply endorsement by the US Government. indexed in MEDLINE, the National Library of Medicine’s premier bibliographic Views expressed are those of the author(s) and do not necessarily reflect database of life sciences and biomedical information. As such, the Journal’s official policies or positions of the Department of the Army, Department of articles are readily accessible to researchers and scholars throughout the the Navy, Department of the Air Force, Department of Defense, nor any other global scientific and academic communities. agency of the US Government. The content does not change or supersede CORRESPONDENCE: Manuscripts, photographs, official unit requests to information in other US Army Publications. The AMEDD Journal reserves the receive copies, and unit address changes or deletions should be sent via right to edit all material submitted for publication (see inside back cover). email to [email protected], or by CONTENT: Content of this publication is not copyright protected. Reprinted regular mail to the above address. Telephone: (210) 221-6301, DSN 471-6301 DISCLAIMER: ma-terial must contain acknowledgement to the original author(s) and the The AMEDD Journal presents clinical and nonclinical AMEDD Journal. professional information to expand knowledge of domestic & international military medical issues and technological advances; promote collaborative OFFICIAL DISTRIBUTION: This publication is targeted to US Army Medical partnerships among Services, components, Corps, and specialties; convey Department units and organizations, other US military medical organizations, clinical and health service support information; and provide a peer-reviewed, and members of the worldwide professional medical community. Infection Precedes Heterotopic Ossification in Combat Wounded Jessica K. Juarez, MS Mary Jo Pugh, PhD Joseph C. Wenke, PhD MAJ Jessica C. Rivera, MC, USA ABSTRACT Heterotopic ossification is the formation of ossified bone in soft tissue, particularly after soft tissue trauma. Heterotopic ossification is known cause of pain, prosthetic/orthotic malfit, and reoperation following combat extremity injury. The purpose of this research was to examine injury and treatment characteristics that are as- sociated with heterotopic ossification in a broader population of deployment-injured subjects. The Department of Defense Trauma Registry and Military Orthopaedic Trauma Registry was queried for a sample of deploy- ment-injured subjects and the complication of heterotopic ossification. Heterotopic ossification was identified in 15% of subjects following 5% of all injuries. Symptoms attributed to the heterotopic bone were present in 40% of subjects with diagnosed with heterotopic ossification. Heterotopic ossification was not associated with injury severity or aggressiveness of open wound treatment. However, infection was the only positive predictor of heterotopic ossification resulting in two-times greater odds of heterotopic bone formation. This finding is consistent with prior research suggesting that heterotopic ossification requires persistent inflammation to be present in at-risk soft tissue. Among all wounds sustained during deployment injury, heterotopic may not be abundantly common; however, the risk may be further minimized by focused infection control. Heterotopic ossification (HO) is the formation of ecto- The published reports cited in the previous paragraph pic bone in abnormal soft tissue locations where it can suggest a high frequency of symptomatic HO, but se- cause pain, joint motion limitation, and neurovascular lectively examine very severe injuries which represent entrapment.1 Heterotopic ossification formation is likely only a portion of combat wounded. When all injuries are driven by excessive local and systemic inflammation taken into account, HO may be an outcome with closer and occurs following many traumatic conditions such frequency to that seen in the civilian trauma literature.4 as severe extremity trauma, certain surgical procedures The first aim of this research was to examine a broader about the hip and pelvis, traumatic brain injury (TBI), cohort of casualties with a wide variety of extremity in- spinal cord injury, and systemic insults such as burn in- juries to determine the frequency of HO without select- jury.2-8 The frequency of extremity HO ranges from 11% ing for the most severe extremity injuries. Our hypoth- to 20% in civilian polytrauma patients.4 esis was that in a broader cohort of combat casualties, the frequency of HO would be less than 20%, similar to Heterotopic ossification is of substantial significance for the civilian trauma population. Secondarily, we aimed injured military personnel because a known risk factor to determine what injury and treatments were associat- for developing HO is exposure to high energy trauma ed with HO formation. We hypothesized that aggressive such as that experienced during an explosion injury.9,10 debridement timing and frequency would be predictive Following combat-related Gustilo and Anderson grade 3 of HO formation. open tibia fractures, HO occurred in 38% of patients and METHODS over one-fourth of these patients required symptomatic HO excision.11 Combat-related amputations are associ- This retrospective cohort study was conducted in ac- ated with a 64% occurrence of HO.12 Symptomatic HO cordance with a research protocol approved by the US is a cause of reoperation for service members with both Army Medical Research and Materiel Command Insti- upper and lower extremity amputations, contributing tutional Review Board. The Military Orthopaedic Trau- to one-fourth of amputation revisions.13,14 Once excised, ma Registry (MOTR) (Joint Trauma System, JBSA Fort
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