Musculoskeletal Trauma: Sustaining Soldier Strength

Musculoskeletal (MSK) injuries are among the most common and operationally disruptive injuries faced by combat personnel, accounting for nearly 60–70% of all battlefield trauma. These injuries can range from life-threatening arterial bleeds and traumatic amputations to limb-threatening fractures and non-urgent sprains or abrasions. Left untreated or mismanaged, they lead to long-term disability, delayed rehabilitation, or even preventable mortality. This chapter outlines a comprehensive, field-adapted approach to the identification, classification, and management of MSK injuries across the spectrum—from urgent battlefield interventions to stabilization techniques using improvised splints and dressings. Emphasis is placed on early hemorrhage control through pressure dressings, hemostatic agents, and combat application tourniquets (CATs), as well as the preservation of amputated parts for potential surgical reattachment. The chapter further details the clinical approach to limb-threatening injuries, such as open fractures and compartment syndrome, highlighting key neurovascular examination steps and decision-making under operational constraints. Additionally, non-urgent injuries, such as sprains, abrasions, and minor fractures, are addressed to support early ambulation and prevent degradation of combat readiness. The utility of field-based immobilization techniques and the importance of pain control and antibiotic prophylaxis are emphasized. Practical case resolution, supported by visuals, provides contextual clarity. By implementing structured MSK injury management in the field, combat providers can sustain soldier strength, reduce secondary complications, and preserve functional mobility in resource-limited, high-threat environments.