War, what is it good for? orthopedics the evolution of orthopedic surgery through armed conflict.

Orthopedic surgery has advanced through the demands of managing complex musculoskeletal trauma on the battlefield. The purpose of this review was to briefly summarize how successive conflicts have shaped principles and practice of orthopedic surgery-from wound management, fracture stabilization, limb salvage, prosthetics, and trauma systems-and to outline possible orthopedic input in future warfare and human exploration. From early empiricism in the Revolutionary War to organized military hospital systems in the Civil War, to the use of antibiotics and internal fixation in World War II, each armed conflict has introduced core orthopedic tenets and innovations. World War I introduced improvements in wound care and early femoral fracture stabilization (Thomas splint), dramatically reducing mortality. World War II brought on the innovation of Küntscher intramedullary nailing and the birth of hand surgery. The Korean and Vietnam wars accelerated evacuation and echeloned care, laying groundwork for damage control orthopedics. In Iraq and Afghanistan, tiered trauma systems and prospective outcomes data reframed limb salvage vs. amputation; contemporary prosthetics (targeted muscle reinnervation, myoelectric control, osseointegration) further expanded function. Future domains-remote warfare and space medicine-pose distinct challenges and research imperatives. Orthopedic surgery's evolution is inseparable from the history of war. Lessons in physiology-first care, principles of bony fixation, wound care, infection control, and multidisciplinary rehabilitation continue to inform modern civilian practice and will be essential for managing complexing injuries in emerging environments. hand, rehabilitation, spine, trauma.