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Introduction

All of the artists in Wounded in Action: An Art Exhibition of Orthopaedic Advancements have explored, both literally and figuratively, their feelings toward the loss of limbs and other musculoskeletal wounds - the majority of which are the result of war. The artists include military personnel who live with orthopaedic injuries and family members who helped them through their recovery process. Orthopaedic surgeons who treat wounded military and civilians and whose lives have been affected by war and their own experience with such injuries are also artists in this exhibition.

None of their relationships to war injuries are simple. Thus, while the artwork can be hopeful, it often disturbs. There is patriotism, but there also is disillusionment. Collectively, it is an acknowledgement that there is real suffering among those with severe war injuries. The exhibition also highlights the need for continued research to improve the ability of Wounded Warriors to reach their full potential and, hopefully, return to service.

Among these brave men and women is Ret. Sgt. Peter J. Damon, whose military training and service in the Iraq War helped him overcome adversity in his personal life. He lost both of his arms in October 2003 while repairing a Blackhawk helicopter. Damon was the lucky one - the accident, a wheel assembly explosion, killed his partner.

Damon's loss made him closer to his family and, through his recovery, he began to believe that anything was possible. This process also drew him back to art, a hobby he had used in Iraq to ward off homesickness. "It became my therapy," says Damon, who presented one of his paintings to then-outgoing President George W. Bush in January 2009. Art "really uplifted me. It lit a spark." He is now settled in Middleboro, Mass., into a new life - one that is driven by art. "It has really evolved from therapy to a passion that consumes most of my time."

Orthopaedic surgeons have played an increasingly pivotal role in the lives of patients like Damon. Advances in medical care and improvements in body and vehicle armor have increased the rate of survival of injured soldiers - from 74.6 percent in the Vietnam War to 90.4 percent in Iraq. But, those who survive are more likely to suffer from traumatic orthopaedic injuries.

Today, about 70 percent of war wounds are musculoskeletal injuries and 7 percent of those with major extremity wounds also sustain loss of limbs. Fractures account for 26 percent of combat injuries, 82 percent of which are open fractures.

The numbers of those affected by these orthopaedic injuries loom large. Between September 11, 2001, the date of the terrorist attacks on the World Trade Center and the Pentagon, and Jan. 8, 2010, 5,317 U.S. service members have lost their lives, and 36,372 have suffered from battle-related injuries. These war wounds put many of them on a long and exhausting road to recovery that has profound implications for them and their families.

Their injuries require the attention of a dedicated team of specialists. In the previously described nine-year period, more than 240 orthopaedic surgeons have provided care for extremity war injuries in combat zones. These physicians not only gained tremendous skill in caring for severe injuries, but also an extraordinary appreciation for the humanity of all those they treat - including those on both sides of a conflict.

Trauma surgeons' war experiences are reflected in the care they provide to service members and their families. They also have made lasting contributions to evidence-based literature in all areas and subspecialties of orthopaedic surgery, benefiting not only Wounded Warriors in conflicts, but also civilians around the world.

The knowledge gained through civilian orthopaedics is quite different from that gained in combat situations. Combat injuries often involve high-velocity shells, which are likely to result in injuries that are more severe than those seen in civilian trauma centers, where injuries from lower velocity bullets are much more typical. Additionally, injuries from explosives are more common in combat.

The area of war injury research, particularly for upper and lower extremities, has led to significant discoveries in recent years. These include advancements in the function of prosthetic limbs, improved bone and soft tissue healing after injuries from explosive devices, and treatments that minimize infection in contaminated war wounds. It's only because of this research and the dedication of many professionals that the wounded survive.

The American Academy of Orthopaedic Surgeons (AAOS), which sponsored this exhibition in partnership with the Orthopaedic Research Society (ORS), the Orthopaedic Trauma Association (OTA) and the Society of Military Orthopaedic Surgeons (SOMOS), supports several research events and programs to advance the care of the Wounded Warrior. An annual symposia series, "Extremity War Injuries," has served to define current knowledge regarding management of extremity war injuries for the National Institutes of Health, the U.S. Congress, the U.S. Department of Defense, orthopaedic surgeons, researchers, orthopaedic industry, and other governmental agencies. Beginning in 2006, the AAOS, along with the OTA and SOMOS, has sponsored five symposia and subsequent publications.

In 2006, the AAOS formed the Extremity War Injuries and Disaster Preparedness Project Team to encourage collaborations between civilian and military surgeons on research and treatment of extremity war and disaster injuries. The AAOS/OTA Landstuhl Distinguished Visiting Scholars Program provides opportunities for experienced civilian trauma surgeons to assist the military surgeons at the Landstuhl Regional Medical Center in Germany, which treats all injured U.S. service members and civilians serving in Afghanistan and Iraq.

There also is federal support for this important research. The Orthopaedic Extremity Trauma Research Program works to broaden clinical research into better treatments and improved clinical outcomes for combat casualties. The Peer Reviewed Orthopaedic Research Program, funded by Congress, investigates a wide scope of musculoskeletal injuries that prevent our military from returning to duty after battlefield injuries. These injuries include spine conditions, arthritis, segmental bone defects, and nerve, muscle, and tendon injuries.

This research gives hope to family members of those who are wounded in war - like Christine Marcum, who was awakened by a phone call in late June 2008 to hear her son had been injured. An active-duty officer for the U.S. Army in Northern Afghanistan, he suffered extensive damage to his right foot and leg after stepping on an explosive anti-personnel device. Marcum spent the next 11 months with him on the campus of Brooke Army Medical Center in San Antonio, Texas. "Our soldier's sufferings are long and many, but he has tremendous courage and fortitude, not to mention a great sense of humor, which has helped us all through his injury," she says.

Her experiences there inspired her to create a three-dimensional, mixed-media book that pays tribute to injured soldiers and their caregivers, who each downplay their sacrifices by saying, "I was just doing my job."

We all benefit from the dedication of Wounded Warriors. However, much of their suffering goes on behind the scenes and is not at the forefront of our collective consciousness. Many of the artists in this exhibition were inspired to create works that remind us, as we go about our daily lives, about the tremendous sacrifices of those who serve their countries in war. We cannot forget that we owe our continued freedom to them, and that we have an obligation to ensure injured troops receive the best possible medical treatment available. This is a long-term commitment, both to treat immediate injuries and provide life-long care, and to support research that improves care for the wounded. Those who suffer traumatic injuries and lose limbs must learn to live again, both physically and psychologically. Orthopaedic surgeons, throughout history, have risked their own safety to care for injured troops and injured civilians, to save lives and limbs, to advance medical treatments and to conduct research and learn from war in order to better treat those who sustain orthopaedic trauma.

This exhibition is truly a tribute to all injured troops, their families, civilians, and the orthopaedic surgeons who care for them as they serve their countries in time of crisis.

The American Academy of Orthopaedic Surgeons