U.S. Army and Air Force to Participate in Austere Environment Training


The 30th MEDCOM will provide real-world and notional support during the training. They are preparing for an austere environment, non-specific injuries, and to work with their peers from Germany and Great Britain. It’s a new concept. The exercise tests the 173rd ABCT’s ability to conduct operations against a modern, capable hybrid threat, an unknown enemy in an under-developed environment.

Learn more about austere environment training

Open Subtrochanteric Femur Fracture Part 2 Now Live


Open Subtrochanteric Femur Fracture


I performed an external fixation and irrigation and debridement of the fracture.  Then I elected to place antibiotic beads in the wound bed while giving the soft tissue in the wound bed time to settle down.

Unfortunately, I’m not thrilled about my currently available options for continued treatment:

1. Repeat irrigation and debridement in 48 hours and treat definitively for multiplanar external fixation

2. Use second generation T2 standard intramedullary nailing

3. Employ a first generation 90 degree dynamic condylar screw (DCS) plate

4. Utilize a latest generation distal locking condylar combination plate

The following fluoro-shots are with implants superimposed over the proximal thigh.

What is your advice on definitive management? 

What would be your prognosis for Kamal’s long-term outcome?

Open Subtrochanteric Femur Fracture – Part 1 Now Live


Kamal, a healthy 20-year-old Afghan male, got caught in cross fire after an improvised explosive device (IED) detonated in his neighborhood. He was brought to a level II field hospital in Southeastern Afghanistan with a gun shot wound through his right anterolateral thigh and multiple exit wounds in his right buttock. Amazingly, Kamal is neurovascularly intact. Although there is an exit wound near his rectum, it does not penetrate it. Kamal is hemodynamically stable and has no other injuries.

Subtrochanteric Femur Fracture Image 1Subtrochanteric Femur Fracture Image 2Subtrochanteric Femur Fracture Image 3

Radiographs show a segmentally comminuted subtrochantric femur fracture.  The fracture includes some of the anterior cortex at the level of the lesser trochanter.

Subtrochanteric Femur Fracture Image 4Subtrochanteric Femur Fracture Image 5

General surgery clears him of a rectal injury and irrigates and debrides his right buttock of secondary shrapnel.

Subtrochanteric Femur Fracture Image 6Subtrochanteric Femur Fracture Image 7

When I saw Kamal, I had the brief thought that would be nice to call in the rep for a trochanteric entry third generation cephalomedullary nail. Then I remembered I was Afghanistan.

What would you suggest as the next steps in treatment in this less than ideal environment?