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called osseointegration and it refers to implants that become directly connected to a bone. Basically, a titanium-based implant is surgically placed into the host limb and becomes permanently fused at its upper end into the remaining bone. e lower end of the implant protrudes slightly below the stump of the limb. Aer the recipient's body has healed from the surgery (usually aer six months), a prosthetic limb can be inserted into a titanium extension (called an abutment) at the lower end of the implant, much in the same way that you insert a beater into a kitchen mixer and click it into place. e prosthetic limb then functions more as an extension of the person's body than a traditionally attached prosthetic can. e abutment eliminates the need for a traditional socket, which reduces the sweating and skin irritation common with traditional prosthetic attachments. Pain and pressure are also reduced compared with traditional socket-based sys- tems. Recipients also report improved functionality and quality of life. Osseointegra- tion doesn't work for every amputee, but it can be a boon for others. e Food and Drug Ad- ministration embarked on a four-year clinical trial of osseointegration last October for patients with above-elbow amputations, while the Osseointe- gration Program at USUHS at Walter Reed is also looking at above-knee amputees. Osseointegration has already been successfully adopted in Europe for patients with both transfemoral and upper-limb amputations, and will presumably become more widespread aer receiving FDA approval. ELECTRONIC HEALTH RECORDS All the medical advances described above are significant, timely, and potentially lifesaving. However, they primarily affect those who are wounded in the field and those who provide their medical care. ere is another significant change in military health care coming soon and this one will affect every member of the military and their families – in the next few years all health records and clinical decision reports will become completely electronic. is may not sound like a radical change in health care and it isn't nearly as intriguing as osseointegrated limbs or arresting a hemorrhage, but it 30 Navy | Summer 2017 SARAH FORTNE Y; AUSN Implant Within the Bone Abutment Soft Tissue Bone Preparing for Osseointegration The initial surgery for osseointegration attaches a fixture or implant onto or within the bone, and the bone takes about three months to grow into the implant. The second surgery prepares the soft tis- sue for an attachment, called an abutment, which protrudes through the skin. Similar to the way a dental implant is secured to the jaw bone, a pros- thetic limb is attached directly to the abutment. The Modular Prosthetic Limb (MPL) was developed as part of a four-year program by the Johns Hopkins Applied Physics Laborato- ry, along with Walter Reed Nation- al Military Medical Center and the Uniformed Services University of the Health Sciences.

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