Combat-Related Hemipelvectomy

Background:The Iran-Iraq imposed war lasted eight years and was one of the longest wars of the last century. Twenty-three years have passed since the war ended, but little has been discussed about the long-term results of war amputations in the literature.Objectives:In this long-term study, we have evaluated the activities of daily living among veterans with hip or hemipelvis amputations.Patients and Methods:A cross-sectional study was performed on Iran-Iraq war veterans with hip or hemipelvis amputations in Iran. Eighty-four (96.5%) veterans out of 87 registered veterans with hip or hemipelvis amputations participated in the study. The degree of independence for activities of daily living (ADL) was assessed by the Barthel index. The degree of independence for instrumental activities of daily living (IADL) was assessed by the Lawton-Brody scale.Results:The average follow-up time was 26.6 ± 3.7 years. The average age of veterans was 44.1±7 years old. Of 84 amputees, 57 (67.85%) had limitations in at least one domain of the ADL. The most common single item that affected the patients was ascending and descending stairs seen in 45 (78.9%) veterans, followed by eating seen in 4 (7.01%) veterans. In addition, 70 (83.33%) had limitations in at least one domain of the IADL. The most common single item that affected the veterans was shopping seen in 56 (80%), followed by responsibility for own medications seen in 13 (18.57%) veterans. Spearman correlation coefficient of the sum scores of ADL and IADL showed an intermediate to strong correlation (r = 0.58).Conclusions:Increasing dependency in ADL is accompanied by increasing dependency in IADL. In the past, the duty of health care providers was saving the life of veterans due to injuries while at present, because these injuries occurred in young and healthy individuals, the need for increased function is being highlighted.

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“…This kind of injury is rare and life threatening and it needs a multidisciplinary team to manage it and its complications (13). …”

Section: Discussionmentioning

confidence: 99%

Disabilities and Activities of Daily Living Among Veterans with Old Hip and Hemipelvis Amputation

et al. 2014

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“…Commonly associated with lower limb amputation, it is consistent with dismounted ‘ foot ’ patrols with the upper limb, elevated and extended in front supporting a weapon 19. The use of early prosthetic limb-fitting for upper limb amputees has been shown to improve final outcome 20.…”

Section: Upper Limb Prosthesismentioning

confidence: 88%

“…Intensive rehabilitation, aimed at restoring function, has been shown to demonstrate a positive effect on both pain and functional levels 19. However, patients often presented with a number of challenges to early intervention such as vision loss and TBI.…”

Section: Early Functionmentioning

confidence: 99%

Lessons learned from early rehabilitation of complex trauma at the Royal Centre for Defence Medicine

Pope

Vickerstaff

Wareham³

2016

J R Army Med Corps

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During the recent conflicts in Iraq and Afghanistan, substantial numbers of service personnel survived devastating injuries, presenting significant challenges for early rehabilitation at Queen Elizabeth Hospital Birmingham. Royal Centre for Defence Medicine personnel augmented NHS therapy provision, gaining significant experience in rehabilitating complex trauma. Multidisciplinary working was key to delivering this service, with a unique rehabilitation coordinating officer position established to manage the rehabilitation pathway. A military exercise rehabilitation instructor provided daily gym-based rehabilitation, developing exercise tolerance. Emphasis was placed on early independence, reducing pain, eliminating complications and optimising function. Innovative solutions and non-standard combinations of rehabilitation were required, with therapy working practices redesigned that, we believe, exceed provision elsewhere, including novel applications such as unique patient transfers, specialist seating, additional equipment, problem-solving teaching and early upper limb prosthetic provision. Active pain management allowed engagement in rehabilitation. With limited evidence available, therapeutic modalities attempting to alleviate phantom limb pain centred on patients' ability to engage in treatment. Finally, the requirement to measure change in early trauma rehabilitation was identified, leading to the development of the preprosthetic functional outcome measure. This article aims to document advances made, lessons learned, encourage debate and identify priorities for future research for military complex trauma rehabilitation.

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“…4Y8 For several decades, amputation was the treatment of choice for advanced extremity tumors. 11 Similarly, combat-related hemipelvectomy is generally indicated if there is insufficient soft tissue coverage after an injury to the proximal limb that is complicated by life-threatening local infection and/or a necrotic and dysvascular hemipelvis after early ligation of critical intrapelvic vasculature. An external or standard hemipelvectomy is most often performed for tumors that cannot be adequately resected through limb-sparing techniques and to provide palliation for patients with pain or distress that cannot be managed with lesser means.…”

mentioning

confidence: 99%

“…Although surgery is the most common treatment of pelvic tumors, radiation therapy and chemotherapy may also be used. 11 Typically, these patients are young and otherwise healthy, requiring long-term medical and rehabilitative care after the amputation. 9,10 Trauma-related hemipelvectomy is a rare, devastating, and often fatal injury that poses a number of challenges to the treating orthopedic trauma surgeon.…”

mentioning

confidence: 99%

Hemipelvectomy

Houdek

Kralovec

Andrews

2014

American Journal of Physical Medicine &Amp; Rehabilitation

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The hemipelvectomy, most commonly performed for pelvic tumor resection, is one of the most technically demanding and invasive surgical procedures performed today. Adequate soft tissue coverage and wound complications after hemipelvectomy are important considerations. Rehabilitation after hemipelvectomy is optimally managed by a multidisciplinary integrated team. Understanding the functional outcomes for this population assists the rehabilitation team to counsel patients, plan goals, and determine discharge needs. The most important rehabilitation goal is the optimal restoration of the patient's functional independence. Factors such as age, sex, etiology, level of amputation, and general health play important roles in determining prosthetic use. The three main criteria for successful prosthetic rehabilitation of patients with high-level amputation are comfort, function, and cosmesis. Recent advances in hip and knee joints have contributed to increased function. Prosthetic use after hemipelvectomy improves balance and decreases the need for a gait aid. Using a prosthesis helps maintain muscle strength and tone, cardiovascular health, and functional mobility. With new advances in prosthetic components, patients are choosing to use their prostheses for primary mobility.

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Combat-Related Hemipelvectomy

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 30 publications

References 30 publications

Disabilities and Activities of Daily Living Among Veterans with Old Hip and Hemipelvis Amputation

Disabilities and Activities of Daily Living Among Veterans with Old Hip and Hemipelvis Amputation

Lessons learned from early rehabilitation of complex trauma at the Royal Centre for Defence Medicine

Hemipelvectomy

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