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Wartime amputations

S Jovanovic1, B Wertheimer, Z Zelic

  • 1Department of Orthopedic Surgery, Osijek University Hospital, Croatia.

Military Medicine
|January 29, 1999
PubMed
Summary
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Extremity amputations occurred in 4.6% of wounded patients due to gunshot-explosive fractures. Most amputations were primary, with few secondary procedures needed for infection or hemorrhage.

Area of Science:

  • Trauma Surgery
  • Military Medicine
  • Orthopedic Surgery

Background:

  • The 1991-1992 conflict in Eastern Slavonia resulted in numerous casualties requiring surgical intervention.
  • Extremity injuries, particularly those from gunshot-explosive mechanisms, posed significant challenges in management.
  • Amputation was a critical consideration for severe limb trauma, necessitating careful evaluation of indications and outcomes.

Purpose of the Study:

  • To analyze the incidence, causes, and anatomical distribution of extremity amputations in wounded patients.
  • To evaluate the types of amputations performed and the management of associated vascular injuries.
  • To review the necessity and outcomes of secondary amputations in the context of war surgery.

Main Methods:

  • Retrospective analysis of medical documentation for 5,024 patients treated at Osijek University Hospital.

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  • Inclusion criteria focused on wounded patients hospitalized between 1991 and 1992.
  • Data extraction included injury types, fracture patterns, surgical procedures (amputations, vascular reconstructions), and secondary interventions.

    • Main Results:

    • 1,560 patients (31.0%) were hospitalized with 1,916 extremity injuries.
    • Gunshot-explosive fractures accounted for 71.9% of injuries.
    • Amputation was performed in 90 cases (4.6%), with 58.9% affecting upper extremities and 41.1% lower extremities. Large amputations (above wrist/ankle) occurred in 2.6% of patients.
    • Primary vascular reconstruction was performed in 44 upper and 96 lower extremity cases.
    • Only 2 secondary amputations were required for vascular insufficiency; none for infection or hemorrhage.

    Conclusions:

    • Amputation rates in this cohort were primarily driven by severe gunshot-explosive fractures.
    • Primary amputations were the predominant surgical approach, with a low rate of secondary amputations.
    • Effective vascular management and surgical expertise are crucial in minimizing the need for secondary amputations in trauma settings.