Traumatic limb amputations at a level I trauma center

Abstract

Traumatic limb amputation is a rare consequence of civilian trauma. Amputation is rarely the primary cause of death; however, these devastating injuries are associated with significant intensive care unit and hospital lengths of stay. Although no mortality difference was detected, when compared with patients with upper extremity amputations, patients with lower extremity amputations were more severely injured, required revision extremity surgery more often, had a higher complication rate, and more frequently required discharge to a long-term facility.

Traumatic extremity amputation in a Nigerian setting: patterns and challenges of care

“…The majority of amputations in Iran were occupational injuries whereas non-occupational injury accounted for the majority of the cases we studied. The differences in the anatomical distribution of amputation between this study and that of Nasser et al could be explained by the findings reported by Kobayashi et al [8] and Lang et al [9]. Kobayashi et al, in a similar study in California, observed that the lower extremity amputation was more likely when the causative factor was road traffic accidents, whereas the upper extremity amputation was more likely in work-related accidents [8].…”

Overall Anatomic Severity and Prognosis in Patients Presenting with, or Requiring a Major Lower Limb Amputation from Civilian Trauma

“…There is a significant difference in kinetic energy between improvised explosive devices (IEDs) blasts and road traffic collisions (RTC); therefore, the severity and characteristics of these injuries are different. In contrast with previous studies [5,[11][12][13], our results show that the most common mechanism of LLA in the civilian population was subway train run-over with 9 (26.4%) patients, and pedestrian run-over, with 8 (23.6%) patients. These results are consistent with the data from the National Trauma Databank [12].…”

“…Consequently, those last three patients had more complications, more operative procedures, and longer hospital LOS than those patients treated with urgent amputation, as is usually the case [14]. Regarding these postoperative complications, the majority of them were related to wound infection, (grade III of the Clavien-Dindo classification), also reported by other studies [5]. Management of these complications required a multidisciplinary approach with participation of plastic, orthopedic, and vascular surgeons.…”

“…most common mechanism [2]. On the other hand, published research on traumatic limb amputations related to civilian trauma are rare [5]. The only similar mechanism causing lower limb amputations (LLA) in civilians is explosions from terrorist attacks; many of these never reach the hospital alive [1].…”

“…Studies in civilian trauma have demonstrated the importance of maintaining maximum length and performing infracondileal amputations rather than supracondileal, reporting better physical quality of life [4]. Unlike the military, the causes of lower limb amputation in the civilian population are diverse, often stemming from traumas resulting in multiple injuries, many of them life-threatening [1,5]. Lower limb amputations have been the topic of several studies by the military [2], but, to our knowledge, only one study has focused on the civilian population [5].…”