Characterisation and outcomes of upper extremity amputations.

Area of Science:

• Military medicine
• Trauma surgery
• Rehabilitation medicine

Background:

• Combat-related extremity amputations are a significant concern for military service members.
• Understanding the specific outcomes for upper extremity amputees is crucial for effective care and rehabilitation.

Purpose of the Study:

• To compare the injuries, outcomes, and disabling conditions of isolated, combat-related upper extremity amputees with those of lower extremity amputees and the general amputee population.
• To identify factors contributing to disability in military amputees.

Main Methods:

• Retrospective study of major extremity amputations in US military service members from October 2001 to July 2011.
• Data sourced from the Department of Defense Trauma Registry, Armed Forces Health Longitudinal Technology Application, and Physical Evaluation Board Liaison Offices.
• Analysis included injury characteristics, demographics, treatment, and disability outcomes.

Main Results:

• 173 isolated upper extremity amputees identified among 1631 total amputations.
• Upper extremity amputees had similar Injury Severity Scores but higher non-battle-related rates (39%) compared to the general population (14%).
• Significantly greater combined disability ratings (82.9%), higher likelihood of >80% disability (69%), and inability to return to duty were observed in upper extremity amputees. Post-traumatic stress disorder (PTSD) and nerve function loss were common disabling conditions.

Conclusions:

• Upper extremity amputees constitute 14% of conflict amputees and experience substantial disability, preventing return to duty.
• While amputation is a primary cause of disability, comorbidities like PTSD significantly contribute to morbidity.
• Specialized care and rehabilitation strategies are needed for upper extremity amputees to address their unique challenges and improve long-term outcomes.