Transhumeral amputation in brachial plexus lesion patients: A multicenter case series
Stijn G C J de Joode1, Martijn G M Schotanus2, Lazin Germawi3
1Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen and Heerlen, Netherlands; Department of Orthopaedic Surgery, Balgrist University Hospital, Zürich, Switzerland; School of Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht, Netherlands.
Background:
A flail limb can be the result of a traumatic complete brachial plexus lesion. Some patients prefer retaining the flail limb, however some patients feel that a flail limb negatively affects daily life. In these circumstances an elective amputation is sometimes elected, however long-term follow-up, with respect to satisfaction and function is unknown. The aim of this study is to evaluate the long-term outcome of this rare and life changing operation.
Materials And Methods:
8 patients with a transhumeral amputation performed in 2 specialized medical centers were included. Postoperatively, the functional- and psychological outcome and the quality of life were evaluated with standardized patient reported outcome measures (PROMs; DASH, SIP-68, EQ-5D-5L and HADS).
Results:
After a median of 9.4 (range 7.5 - 12.8) years follow-up, 7 patients (88%) stated that they would undergo the operation again and were satisfied with the results. At latest follow-up the median DASH score was 37.3 (range 8.3-61.7), the median SIP-68 score was 6.5 (range 0-43) and the median HADS score was 3.0 (range 0-14) for anxiety and 3.0 (range 1-19) for depression. In the EQ-5D-5L patients had most difficulties in self-care, usual activities and pain/discomfort. The median overall health status was 69 (range 20-95).
Discussion:
With the right indication a transhumeral amputation is a reasonable option for traumatic complete brachial plexus lesion with satisfying long-term results.
Level Of Evidence:
IV, multicenter case series.
