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Journal articles on the topic 'Amputation rehabilitation'
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1
Jandric, Slavica, and Brano Topic. "Effect of primary and secondary wartime below-knee amputation on length of hospitalization and rehabilitation." Vojnosanitetski pregled 59, no. 3 (2002): 261–64. http://dx.doi.org/10.2298/vsp0203261j.
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The results of below-knee amputations in 36 war wounded (mean age 35,42) were reviewed. The majority of the patients was wounded by land mines (94.4%). Most of them were between 25 and 35 years old. Bilateral amputation was done in 2.8% of cases. The amputation was performed on the day of wounding (primary below-knee amputation) in 30 (83.3%) amputees. Secondary amputation after the attempt to save the severely injured lower-limb was performed in 6 patients (16,7%) average 4.61 ? 11.67 days after wounding. Reamputation was necessary in 6 cases (16.7%). Time period from the beginning of rehabilitation to the fitting of prosthesis, was 36.25 ? 14.97 days for primary amputations, 32 ? 17.8 days for secondary amputations and 68.66 ? 33.52 days for reamputations. There was no significant correlation between the duration of rehabilitation to prosthetic management and the period between wounding and amputation (r = -0.102). The attempt to save the limb after severe below-knee injuries and the secondary amputation afterwards, did not significantly influence the ensuing rehabilitation and prosthetic works.
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Karmarkar, Amol M., James E. Graham, Timothy A. Reistetter, Amit Kumar, Jacqueline M. Mix, Paulette Niewczyk, Carl V. Granger, and Kenneth J. Ottenbacher. "Association between Functional Severity and Amputation Type with Rehabilitation Outcomes in Patients with Lower Limb Amputation." Rehabilitation Research and Practice 2014 (2014): 1–7. http://dx.doi.org/10.1155/2014/961798.
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The purpose of this study was to determine independent influences of functional level and lower limb amputation type on inpatient rehabilitation outcomes. We conducted a secondary data analysis for patients with lower limb amputation who received inpatient medical rehabilitation (N= 26,501). The study outcomes included length of stay, discharge functional status, and community discharge. Predictors included the 3-level case mix group variable and a 4-category amputation variable. Age of the sample was 64.5 years (13.4) and 64% were male. More than 75% of patients had a dysvascular-related amputation. Patients with bilateral transfemoral amputations and higher functional severity experienced longest lengths of stay (average 13.7 days) and lowest functional rating at discharge (average 79.4). Likelihood of community discharge was significantly lower for those in more functionally severe patients but did not differ between amputation categories. Functional levels and amputation type are associated with rehabilitation outcomes in inpatient rehabilitation settings. Patients with transfemoral amputations and those in case mix group 1003 (admission motor score less than 36.25) generally experience poorer outcomes than those in other case mix groups. These relationships may be associated with other demographic and/or health factors, which should be explored in future research.
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Lubina, Alisa, and Daina Smite. "State-funded rehabilitation service and continuity of service in Latvia for patients with unilateral lower limb amputations: Statistical data and patients' view." SHS Web of Conferences 85 (2020): 02005. http://dx.doi.org/10.1051/shsconf/20208502005.
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Amputation is much more common than people do realize. There are no statistical data on amputations in Latvia, also any guidelines for planning, organizing and providing rehabilitation services to patients after amputation. Providing a patient-friendly and comprehensive multidisciplinary treatment is the key to successful outcomes in the case of amputation. The analysis of the current situation, including patients' view, will serve as one of the steps to improve the rehabilitation of patients with unilateral lower limb amputation in Latvia.
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Dillon, Michael P., Friedbert Kohler, and Victoria Peeva. "Incidence of lower limb amputation in Australian hospitals from 2000 to 2010." Prosthetics and Orthotics International 38, no. 2 (June 24, 2013): 122–32. http://dx.doi.org/10.1177/0309364613490441.
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Background: Contemporary literature reports that the incidence of lower limb amputation has declined in many countries. This impression may be misleading given that many publications only describe the incidence of lower limb amputations above the ankle and fail to include lower limb amputations below the ankle. Objectives: To describe trends in the incidence of different levels of lower limb amputation in Australian hospitals over a 10-year period. Study design: Descriptive. Method: Data describing the age-standardised incidence of lower limb amputation were calculated from the Australian National Hospital Morbidity database and analysed for trends over a 10-year period. Results: The age-standardised incidence of lower limb amputation remained unchanged over time ( p = 0.786). A significant increase in the incidence of partial foot amputations ( p = 0.001) and a decline in the incidence of transfemoral ( p = 0.00) and transtibial amputations ( p = 0.00) were observed. There are now three lower limb amputations below the ankle for every lower limb amputation above the ankle. Conclusion: While the age-standardised incidence of all lower limb amputation has not changed, a shift in the proportion of lower limb amputations above the ankle and lower limb amputations below the ankle may be the result of improved management of precursor disease that makes partial foot amputation a more commonly utilised alternative to lower limb amputations above the ankle. Clinical relevance This article highlights that although the incidence of lower limb amputation has remained steady, the proportion of amputations above the ankle and below the ankle has changed dramatically over the last decade. This has implications for how we judge the success of efforts to reduce the incidence of lower limb amputation and the services required to meet the increasing proportion of persons with amputation below the ankle.
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Esquenazi, Alberto, and Robert DiGiacomo. "Rehabilitation After Amputation." Journal of the American Podiatric Medical Association 91, no. 1 (January 1, 2001): 13–22. http://dx.doi.org/10.7547/87507315-91-1-13.
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The principles of amputee rehabilitation, from preamputation to reintegration into the work force and community, are reviewed. The authors discuss exercise techniques, training programs, and environmental modifications that have been found to be helpful in the rehabilitation of the amputee. The exercise programs presented here are divided into four main components: flexibility, muscle strength, cardiovascular training, and balance and gait. The programs include interventions by the physical, occupational, and recreational therapist under the supervision and guidance of a physician. (J Am Podiatr Med Assoc 91(1): 13-22, 2001)
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Marshall, Colette, and Gerry Stansby. "Amputation and rehabilitation." Surgery (Oxford) 28, no. 6 (June 2010): 284–87. http://dx.doi.org/10.1016/j.mpsur.2010.01.017.
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Marshall, Colette, and Gerry Stansby. "Amputation and rehabilitation." Surgery (Oxford) 31, no. 5 (May 2013): 236–39. http://dx.doi.org/10.1016/j.mpsur.2013.03.002.
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Marshall, Colette, Tarig Barakat, and Gerry Stansby. "Amputation and rehabilitation." Surgery (Oxford) 34, no. 4 (April 2016): 188–91. http://dx.doi.org/10.1016/j.mpsur.2016.02.006.
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Guest, Francesca, Colette Marshall, and Gerry Stansby. "Amputation and rehabilitation." Surgery (Oxford) 37, no. 2 (February 2019): 102–5. http://dx.doi.org/10.1016/j.mpsur.2018.12.008.
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Kim, Y. C., C. I. Park, D. Y. Kim, T. S. Kim, and J. C. Shin. "Statistical analysis of amputations and trends in Korea." Prosthetics and Orthotics International 20, no. 2 (August 1996): 88–95. http://dx.doi.org/10.3109/03093649609164424.
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Epidemiological research on amputees is being continued extensively world wide, but there are different epidemiologic reports from country to country. This study undertakes an epidemiologic report of the medical records of amputees in Korea which has developed very rapidly, when compared with other countries. This study included 4258 amputees who either had an amputation and/or received prosthetic training at Yonsei University College of Medicine, Severance Hospital from January 1970 to June 1994. The most common cause of amputation was trauma (66.7%), and the second most common cause was peripheral vascular disease. While amputations due to infection or trauma were the most common in the 1950's, amputations due to peripheral vascular disease have gradually increased until they now make up 23.5% of all amputations in the 1990's. Lower limb amputation, more common than upper limb amputation, accounted for 68.7% of all amputations. Multiple amputation accounted for 9.3% of all amputations, and the occurrence rate of multiple amputation was relatively higher in cases of burn injuries, train accidents, frostbite, and Buerger's disease than in cases brought about by other causes. The various amputation causes change according to the circumstances of the times, as can be seen in this study.
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Pohjolainen, T., and H. Alaranta. "Lower limb amputations in Southern Finland 1984-1985." Prosthetics and Orthotics International 12, no. 1 (April 1988): 9–18. http://dx.doi.org/10.3109/03093648809079386.
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To assess the current epidemiological situation concerning lower limb amputations in southern Finland the data on all amputations made in the catchment area of the Helsinki University Central Hospital were analysed for the period 1984-85. During the two-year period, 880 amputations of lower limbs were performed on 705 patients. The amputation rate was 32.5 per 100,000 inhabitants in 1984 and 28.1 in 1985. Patients requiring amputation were arteriosclerotics in 43.1 per cent, and diabetics in 40.7 per cent. Diabetics underwent amputation 3 years younger on average than the arteriosclerotics. The most common site of unilateral amputations was above-knee (42.0 per cent) followed by below-knee (27.7 per cent) and toe amputations (22.2 per cent). The level of amputation tended to become more proximal with increasing age of the patients. The overall mortality figure during three postoperative months was 27.0 per cent. Amputation incidence increased sharply with increasing age. On the base of predictions, the overall age structure of the Finnish population will shift upward causing an increase in the proportion of elderly age groups. A 50% increase in amputation rate is expected in Finland within the next 20-30 years.
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Ebskov, L. B. "Level of lower limb amputation in relation to etiology: An epidemiological study." Prosthetics and Orthotics International 16, no. 3 (December 1992): 163–67. http://dx.doi.org/10.3109/03093649209164335.
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The Danish Amputation Register and the nationwide National Patient Register are presented. Based upon the code numbers in the WHO classification system (ICD), 4 etiology groups i.e. vascular insufficiency, diabetes mellitus, malignant neoplasma and trauma were extracted. The purpose was to analyse the relationship between level of amputation (i.e. foot, below-knee, through-knee, above-knee and hip) and etiology (cause of amputation). The material represents all such amputations in Denmark during the period 1978 to 1989 (n=25.767). The number of amputations because of vascular insufficiency with and without diabetes mellitus decreased over the period studied. The number of tumour and trauma amputations seemed unchanged. There was a significant reduction in the number of amputations at proximal levels (above-knee) for vascular insufficiency with and without diabetes mellitus and in the trauma group. No such change was found regarding tumour amputations. There was a characteristic pattern in the distribution of level respectively of etiological factors for each etiology group and for each level of amputation.
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Heikkinen, M., J. Saarinen, V. P. Suominen, J. Virkkunen, and J. Salenius. "Lower limb amputations: Differences between the genders and long-term survival." Prosthetics and Orthotics International 31, no. 3 (September 2007): 277–86. http://dx.doi.org/10.1080/03093640601040244.
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The purpose of the study was to evaluate possible differences between genders in amputation incidence, revascularization activity before and survival after amputation. This population-based study was carried out in a well-defined geographical area, where all vascular surgical consultations and reconstructions are performed in one university hospital. All amputations performed in the region during 1990 – 1999 were identified from the hospital central registers. According to patient's identity codes, the Cause of Death Registry of Statistics Finland provided death data. Amputation data were cross-linked with the local vascular registry using identity codes. Women were found to be 8 years older than men ( p < 0.0001). Major amputations comprised 73.4% in males and 77.7% in females. The age-standardized amputation incidence among males was 338 and among females 226 (per 106 inhabitants/year) ( p < 0.001). The most prominent difference was seen in amputations due to trauma, where the age-adjusted major amputation incidence was over three-fold among males compared to females. The proportion of patients who had undergone vascular procedure before amputation was 23% in both genders. Median survival after amputation was 943 days in men and 716 in women ( p = 0.01). When the higher age of women was considered, there was no significant difference between the genders. Survival was poorer among diabetics in both genders and the difference was significant in males. The amputation incidence was found to be higher in men compared to women in all etiologic subgroups except malignant tumour. Almost one in 4 patients had undergone vascular surgical reconstruction before amputation in both genders. There was no significant difference between the genders in survival after amputation. Subjects with diabetes had a poorer survival after major amputation than those without diabetes.
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Resnik, Linda J., and Matthew L. Borgia. "Factors Associated With Utilization of Preoperative and Postoperative Rehabilitation Services by Patients With Amputation in the VA System: An Observational Study." Physical Therapy 93, no. 9 (September 1, 2013): 1197–210. http://dx.doi.org/10.2522/ptj.20120415.
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Background The Department of Veterans Affairs (VA) and the Department of Defense published evidence-based guidelines to standardize and improve rehabilitation of veterans with lower limb amputations; however, no studies have examined the guidelines' impact. Objectives The purposes of this study were: (1) to describe the utilization of rehabilitative services in the acute care setting by people who underwent major lower limb amputation in the VA from 2005 to 2010, (2) to identify factors associated with receipt of rehabilitation services, and (3) to examine the impact of the guidelines on service receipt. Design A cross-sectional study of 12,599 patients, who underwent major surgical amputation of the lower limb at a VA medical center from January 1, 2005, to December 31, 2010, was conducted. Data were obtained from main and surgical inpatient datasets and the inpatient encounters files of the Veterans Health Administration databases. Methods Rehabilitation services were categorized as physical therapy, occupational therapy, and either (any therapy), before or after amputation. Separate multivariate logistic regressions examined the impact of guideline implementation and identified factors associated with service receipt. Results Patients were 1.45 and 1.73 times more likely to receive preoperative physical therapy and occupational therapy and 1.68 and 1.79 times more likely to receive postoperative physical therapy and occupational therapy after guideline implementation. Patients in the Northeast had the lowest likelihood of receiving preoperative and postoperative rehabilitation services, whereas patients in the West had the highest likelihood. Other patient characteristics associated with service receipt were identified. Limitations The sample included only veterans who had surgeries at VA Medical Centers and cannot be generalized to veterans with surgeries outside the VA or to nonveteran patients and settings. Conclusions Further quality improvement efforts are needed to standardize delivery of rehabilitation services for veterans with amputations in the acute care setting.
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Ohmine, Saburo, Yoshiko Kimura, Satoru Saeki, and Kenji Hachisuka. "Community-based survey of amputation derived from the physically disabled person’s certification in Kitakyushu City, Japan." Prosthetics and Orthotics International 36, no. 2 (February 7, 2012): 196–202. http://dx.doi.org/10.1177/0309364611433443.
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Background: There were no recent reports of community-based surveys on the incidence, level and causes of amputation in Japan.Objectives: To identify any changes in the incidence, level, causes of amputation and gender distribution.Study Design: A community-based survey.Methods: The subjects were Kitakyushu-citizens amputated between 2001 and 2005 and selected based on medical certificates for the physically disabled person’s certificate.Results: The incidence of amputation (/100,000 population per year) was 6.9 overall, 1.4 for upper limbs and 5.8 for lower limbs. The average age at amputation was 63.5 ± 20.1 years and the male:female ratio was 1.9:1. The most frequent levels of amputations were partial hand amputation (84.4%) for upper limbs, and transtibial amputation (42.3%) and transfemoral amputation (36.8%) for lower limbs. The major causes were injuries (54.3%) for upper limbs, and peripheral vascular disorder (49.0%) and diabetes mellitus with peripheral circulatory complications (28.6%) for lower limbs.Conclusions: The incidence of amputation was 6.9 overall, 1.4 for upper limbs and 5.8 for lower limbs, and the male:female ratio was 1.9:1. In comparison to a previous survey the percentages of amputation due to peripheral circulatory disorders and injuries increased and decreased, respectively, and the rate of female amputations increased.Clinical relevanceThis study provides useful data about change of the recent epidemiology of amputation in Kitakyushu, Japan. These data are essential to perform clinical practices in amputation rehabilitation, including prescription of prosthesis, general fatigue for aged amputees, and complication of peripheral circulatory disorders.
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Knezevic, Aleksandar, Tatjana Salamon, Miroslav Milankov, Srdjan Ninkovic, Milica Jeremic-Knezevic, and Snezana Tomasevic-Todorovic. "Assessment of quality of life in patients after lower limb amputation." Medical review 68, no. 3-4 (2015): 103–8. http://dx.doi.org/10.2298/mpns1504103k.
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Introduction. Lower extremity amputation is a surgical procedure resulting in important anatomical, functional, psychological, and social consequences that can influence the quality of life of these patients. The aim of this research was to compare the quality of life of patients with lower extremity amputation and people without amputation taking into account gender differences as well as the amputation level. Material and Methods. The study was designed as a cross-sectional study which included 56 subjects. The patients from the experimental group underwent prosthetic rehabilitation treatment at the Department of Medical Rehabilitation, Clinical Centre of Vojvodina. The experimental group included 28 patients (21 male, 7 female) with lower extremity amputation, their average age being 65.36?13.64. The control group consisted of 28 age and gender matching subjects without amputation. Research ANd Development (RAND) 36 - Item Health Survey 1.0 (SF - 36) was used to measure the quality of life. Results. The results showed that patients with lower extremity amputation scored lower than the control group on all SF- 36 variables (p<0.05). None of the SF-36 variables differed between the genders (p>0.05). Seventeen (61%) patients were with transfemoral, and 11 (39%) with transtibial level of amputation. The patients with transtibial amputations scored higher on physical functioning and general health status variables (p<0.05). Conclusion. The patients with lower extremity amputations have numerous limitations compared to the control group, regardless of gender, while the patients with lower level of amputation have a higher level of physical functioning.
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Bartley, Colleen N., Kenisha Atwell, Laura Purcell, Bruce Cairns, and Anthony Charles. "Amputation Following Burn Injury." Journal of Burn Care & Research 40, no. 4 (April 23, 2019): 430–36. http://dx.doi.org/10.1093/jbcr/irz034.
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AbstractAmputation following burn injury is rare. Previous studies describe the risk of amputation after electrical burn injuries. Therefore, we describe the distribution of amputations and evaluate risk factors for amputation following burn injury at a large regional burn center. We conducted a retrospective analysis of patients ≥17 years admitted from January 2002 to December 2015. Patients who did and did not undergo an amputation procedure were compared. A multivariate logistic regression model was used to determine the risk factors for amputation. Amputations were further categorized by extremity location and type (major, minor) for comparison. Of the 8313 patients included for analysis, 1.4% had at least one amputation (n = 119). Amputees were older (46.7 ± 17.4 years) than nonamputees (42.6 ± 16.8 years; P = .009). The majority of amputees were white (47.9%) followed by black (39.5%) when compared with nonamputees (white: 57.1%, black: 27.3%; P = .012). The most common burn etiology for amputees was flame (41.2%) followed by electrical (23.5%) and other (21.9%). Black race (odds ratio [OR]: 2.29; 95% confidence interval [CI]: 1.22–4.30; P = .010), electric (OR: 13.54; 95% CI: 6.23–29.45; P < .001) and increased %TBSA (OR: 1.03; 95% CI: 1.02–1.05; P < .001) were associated with amputation. Burn etiology, the presence of preexisting comorbidities, black race, and increased %TBSA increase the odds of post burn injury. The role of race on the risk of amputation requires further study.
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Hagberg, E., Ö. K. Berlin, and P. Renström. "Function after through-knee compared with below-knee and above-knee amputation." Prosthetics and Orthotics International 16, no. 3 (December 1992): 168–73. http://dx.doi.org/10.3109/03093649209164336.
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Fifty-nine amuptees, 24 below-knee (BK), 17 through-knee (TK) and 18 above-knee (AK) who had prosthetic replacements, were evaluated using a questionnaire which provided a quantitative and qualitative assessment scale for the prosthetic function. The ability to apply or don the prosthesis was noted in 100% of the BK, 70% of the TK and 56% of the AK amputations (p < 0.001). Daily use of the prosthesis was recorded in 96% of the BK, 76% of the TK and 50% of the AK amputations (p < 0.001). A higher level of amputation resulted in a significantly lower degree of rehabilitation (p < 0.05). The qualitative evaluation shows that the higher the level of amputation, the lower the usefulness of the prosthesis. Four percent of the BK, 12% of the TK and 39% of the AK amputees had no use whatsoever of their prosthesis (p < 0.01). From a functional standpoint, TK amputation should always be considered as the primary alternative to AK amputation when a BK amputation is not feasible.
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Sturup, J., H. C. Thyregod, J. S. Jensen, J. B. Retpen, G. Boberg, E. Rasmussen, and S. Jensen. "Traumatic amputation of the upper limb: the use of body-powered prostheses and employment consequences." Prosthetics and Orthotics International 12, no. 1 (April 1988): 50–52. http://dx.doi.org/10.3109/03093648809079390.
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Forty three patients with unilateral traumatic amputations were reviewed as to the use of prostheses and employment consequences of the amputation. Seventeen of 19 below-elbow amputees, and 12 of 24 above-elbow amputees used their prostheses. Non-users compared to users of prostheses were characterized by: 1) Higher level of amputation 2) Non-dominant arm amputation and 3) Younger age at the time of amputation. However non-users usually did well on the labour market for various reasons.
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Loro, A., F. Franceschi, E. C. P. Mosha, and J. Samwel. "A survey of amputations at Dodoma Regional Hospital, Tanzania." Prosthetics and Orthotics International 14, no. 2 (August 1990): 71–74. http://dx.doi.org/10.3109/03093649009080325.
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A survey of 143 amputations performed at Dodoma Regional Hospital, Tanzania between 1983 and 1988 is presented. Consideration is given to indications for amputation, amputation levels, stump revision and supply of prostheses.
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Niekerk, L. J. A. van, C. P. U. Stewart, and A. S. Jain. "Major lower limb amputation following failed infrainguinal vascular bypass surgery: A prospective study on amputation levels and stump complications." Prosthetics and Orthotics International 25, no. 1 (April 2001): 29–33. http://dx.doi.org/10.1080/03093640108726565.
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The effect of failed vascular bypass surgery on final amputation level and stump complications is the subject of debate. The aim of this prospective cohort study was to assess the influence of previous infrainguinal bypass surgery on amputees in the authors’ centre. Over a three-year period, 234 amputations (219 patients) were performed for critical ischemia. The cause of ischemia was either peripheral obstructive arterial disease (POAD) or diabetes mellitus (DM). Forty-eight percent (48%) (113 amputations) had ipsilateral vascular bypass surgery prior to amputation and 52% (121 amputations) had not. Final amputation level and the post-operative complications of infection, significant stump pain and delayed wound healing were used as the outcome measures for this study. At the end of the study period these outcome measures were used to compare the influence of previous bypass surgery on the two groups of amputees. There was a significantly higher rate of trans-femoral amputations (TFA) (32.7% vs. 16.5%; p<0.05) and stump infection rate (42% vs. 23%; p<0.05) in the bypass group. Significant stump pain (p=0.23) and delayed wound healing (p=0.24) was more prevalent in the bypass group although statistical significance could not be demonstrated. Bypass surgery prejudices the amputation level and stump infection rate. Further studies are required to identify the group of patients who would benefit from primary amputation for critical ischemia.
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Kauzlarić, N., K. Sekelj-Kauzlarić, and M. Jelić. "Experience in prosthetic supply of patients with lower limb amputations in Croatia." Prosthetics and Orthotics International 26, no. 2 (August 2002): 93–100. http://dx.doi.org/10.1080/03093640208726631.
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This study analyses some demographic characteristics of the amputees in Croatia, reason and level of amputation, care the amputees receive, the first prosthetic supply and functional level after rehabilitation. Anonymised data on all amputees in the Clinical Institute for Rehabilitation and Orthopaedic Aids in Zagreb (a national centre) were collected during the year 2000. Follow-up was undertaken for one year. As a result, the authors analysed 221 patients, classified into 3 groups according to the level of amputations: trans-tibial, except foot (TT), trans-femoral (TF) and bilateral amputations (bilateral). Among the population there were: 76% men and 24% women with average age of about 62 years (the average age of women was 8 years more than men). The most common diseases that resulted in amputation were: diabetes mellitus (DM) 48.9%; obstructive vascular diseases (OD): occlusive peripheral arterial disease, Buerger's disease and atherosclerosis 27.1%; trauma 11.3%; both OD and DM 7.2%; osteomyelitis (OM) 3.2% and tumours (TM) 2.3%. Average period from the amputation to admission for prosthetic supply was over 190 days but the average period from admission to discharge from the Institute was about 40 days. Prosthetic supply was accompanied by certain complications: flexion contractures of neighbouring joints, knee 37.9% and hip 35.2%; local complications of soft tissues: necrosis, wound dehiscence, soft tissue surplus, ischaemic tissue damage (the most frequent in TT amputation 35.9%) and phantom pain (55.7% of patients). Hours of daily use of the prosthesis at discharge was about 5 hours. Greater independence in fitting and removing the prosthesis was observed in patients with TT amputation (86.4%). In conclusion, it can be said that the time between the amputation and the beginning of the prosthetic supply, mobility at the time of admission, frequency of general and local complications and number of days in prosthetic supply, are very important for the result of rehabilitation.
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SOOMRO, NABILA, RUKHSANA BIBI, SYED IMRAN AHMED, Brigitte Kamran, Muhammad Ali Minhas, and Kamran Yousuf Siddiqui. "EPIDEMIOLOGY OF AMPUTATION;." Professional Medical Journal 20, no. 02 (February 7, 2013): 261–65. http://dx.doi.org/10.29309/tpmj/2013.20.02.685.
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Amputation is stated to be a foremost but preventable community health problem causing intense financial, social andemotional effects on the patient and family particularly in developing countries where the prosthetic services are limited. The purpose ofthis study was to identify the causes and levels of amputation in low resource community, Sindh Pakistan. Methods: This was aretrospective chart review study that was carried out at first civilian Institute of physical medicine & rehabilitation-Dow University of healthsciences from October 2007 to June 2012. After verbal informed consent all patients, who underwent major or minor amputation wereenrolled for the study. Data was collected using a pre-tested, coded questionnaire and analysed using SPSS version 16. Results: A total of1115 patients were enrolled into the study. Their ages were ranged between 2–95 years (mean 38.40±17.38). Among total population ofamputees 83.58% were males. The most common cause for major limb amputation was road Traffic accident 38.38%, followed byDiabetes 15.42%, infection 14.26% and trauma 12.37%. Lower limbs (trans-tibial) amputations were in 47.35% of cases and transfemoralin 27.98% of cases. While for the upper limb trans-radial amputation (7.4%) were found to be more common than trans-humeral(5.56%). Other amputations were for shoulder, hip and knee disarticulations. Conclusions: Road traffic accidents, complications ofdiabetic foot ulcers, infections and trauma were the most common causes for major limb amputations found in low resource community,Sindh Pakistan. The majority of these amputations are preventable by endowment of traffic rules, health education, early preventions andappropriate management of the common infections.
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Baumfeld, Daniel, Tiago Baumfeld, Benjamim Macedo, Roberto Zambelli, Fernando Lopes, and Caio Nery. "FACTORS RELATED TO AMPUTATION LEVEL AND WOUND HEALING IN DIABETIC PATIENTS." Acta Ortopédica Brasileira 26, no. 5 (October 2018): 342–45. http://dx.doi.org/10.1590/1413-785220182605173445.
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ABSTRACT Objective: There are no specific criteria that define the level of amputation in diabetic patients. The objective of this study was to assess the influence of clinical and laboratory parameters in determining the level of amputation and the wound healing time. Methods: One hundred and thirty-nine diabetic patients were retrospectively assessed. They underwent surgical procedures due to infection and/or ischemic necrosis. Type of surgery, antibiotic use, laboratory parameters and length of hospital stay were evaluated in this study. Results: The most common amputation level was transmetatarsal, occurring in 26 patients (28.9%). The wound healing time increased with statistical significance in individuals undergoing debridement, who did not receive preoperative antibiotics and did not undergo vascular intervention. Higher levels of amputation were statistically related to limb ischemia, previous amputation and non-use of preoperative antibiotics. Conclusion: Patients with minor amputations undergo stump revision surgery more often, but the act of always targeting the most distal stump possible decreases energy expenditure while walking, allowing patients to achieve better quality of life. Risk factors for major amputations were ischemia and previous amputations. A protective factor was preoperative antibiotic therapy. Level of Evidence III, Retrospective Study.
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Pohjolainen, T., and H. Alaranta. "Epidemiology of lower limb amputees in Southern Finland in 1995 and trends since 1984." Prosthetics and Orthotics International 23, no. 2 (August 1999): 88–92. http://dx.doi.org/10.3109/03093649909071618.
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The purpose of this study was to look at the current epidemiological trends of lower limb amputees in 1995 and the trends since 1984 in the area of Southern Finland with 1.3 million inhabitants. During the one-year period, the lower limb amputation was performed on 366 patients. The overall amputation rate has been unchanged since 1984 being 28.0 per 100,000 inhabitants in 1995. The mean age was 71.4 years. The overall amputation rate was 28.0 per 100,000 inhabitants. Of the 366 patients in the study 30% had arteriosclerosis without diabetes mellitus and 49% had diabetes. Diabetes mellitus has become the most common cause of amputation since 1985. Tumours were the cause in 2% and trauma in 4%. The most common unilateral amputations were trans-femoral amputations (29%) followed by trans-tibial amputations (28%) and toe amputations (24%). The unilateral trans-tibial/trans-femoral ratio was 0.54 in 1984 and 0.95 in 1995. The one-year mortality rate was 39% in 1984 and 40% in 1995. The rate of amputation has been relatively constant over the last ten years. The age related incidence in the older age groups has also been unchanged over the last ten years. Better control of diabetes and prophylactic foot care of diabetics can have a positive contribution in preventation of lower limb amputations. The current rehabilitation and prosthetic services of the lower limb amputees can be planned in the south of Finland on the basis of the incidence of 28 per 100,000 inhabitants.
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O'Keeffe, Bernard, and Shraddha Rout. "Prosthetic Rehabilitation in the Lower Limb." Indian Journal of Plastic Surgery 52, no. 01 (January 2019): 134–43. http://dx.doi.org/10.1055/s-0039-1687919.
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AbstractLower limb amputations form a considerable number with 5,436,000 Indians having locomotor disability. Most members of this group are young, active earning males. The major cause of amputation is trauma. Hence, this population must be rehabilitated with priority, and best concerted efforts must be made by the medical community. In this article, the authors present available modern technologies in India and share best practices from their experience of treating Indian amputees for the past 20 years. The objective is to demonstrate to the medical community the optimal outcomes that can be achieved and help them make correct decisions on behalf of patients and their families. The article discusses history of prostheses, how to select optimal amputation level, preamputation preparation, determinants of good outcomes, preprosthetic preparation, components of prosthesis, their function and significance, rehabilitation process and guidelines, prescription criteria, and also special considerations such as multiple amputees or children.
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Yilleng, SB, and DD Dapap. "Evaluation of Early Psychological symptoms of Major Limb Amputation in a Tertiary Hospital." Journal of BioMedical Research and Clinical Practice 3, no. 3 (December 1, 2020): 389–95. http://dx.doi.org/10.46912/jbrcp.192.
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Amputation may be used to treat a diseased limb or improve its function, and it is considered the last, albeit valuable option when limb salvage is impossible. The decision to amputate a limb is an emotional process for the patient and the patient's family. The result is often loss of economic power of the individual and his/her independence when not sufficiently rehabilitated back into the society. The aim of the study was to determine early psychological outcome of major limb amputation. This was a prospective study, where 54 consenting patients admitted via either the accident and emergency unit or general outpatient clinic of a tertiary hospital for major limb amputation that met the inclusion criteria were recruited into the study consecutively over a period of one year. They were assessed for depression with Mini International Neuropsychiatric Interview (MINI) Instrument, while Rehabilitation outcome was graded using functional independence measure. Intensive counseling with psycho education was commence before amputation and continues after amputation by counselors. Physiotherapy, occupational therapy, coping skills and other life skill training commence after amputation to 3 months of follow up. Only 1 (1.9%) of the respondents was diagnosed with major depressive episode out of the 54 that completed the study. Some of the remaining 53 (98.1%) had few symptoms of depression but did not fulfilled the diagnostic criteria for major depressive episode according to M.I.N.I. The rehabilitation of all the patients were good with a mean functional measure score of 117.59 (sd=3.328) and a P-value of 0.00 at discharge and even after follow up. Our findings show that early and proper rehabilitation of amputees seem to reduce their psychological symptoms. Tendency to get depressed following amputation is more common in the younger age group, female gender and in amputations as a result of trauma while rehabilitation seems better in same and vice versa.
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Francis, W., and C. J. C. Renton. "Mobility after major limb amputation for arterial occlusive disease." Prosthetics and Orthotics International 11, no. 2 (August 1987): 85–89. http://dx.doi.org/10.3109/03093648709078184.
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This study is concerned with the degree of mobility achieved by patients following major amputation for arterial occlusive disease of the legs and its relationship to the level of amputation. Eighty-four out of a possible 85 consecutive amputees form the basis of the study and the degree of mobility was assessed and graded in survivors six months after amputation. Of the 69 survivors 74% were mobile to some degree and 57% walked daily with a prosthesis. Sixty-five per cent of all the amputations were below-knee. Seventeen per cent of below-knee stumps in patients surviving two weeks failed to heal. In amputees who attained a unilateral mobile healed stump 78% with below-knee amputations and 50% with above-knee amputations walked daily with a prosthesis. To obtain maximum mobility the knee should be retained whenever practical even though this results in some unhealed stumps requiring revision.
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Naidoo, Ugendrie, and Liezel Ennion. "Barriers and facilitators to utilisation of rehabilitation services amongst persons with lower-limb amputations in a rural community in South Africa." Prosthetics and Orthotics International 43, no. 1 (July 25, 2018): 95–103. http://dx.doi.org/10.1177/0309364618789457.
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Background: Persons with disabilities who reside in rural areas experience challenges accessing and utilising health services and rehabilitation. Due to the high prevalence of diabetes mellitus in rural regions, the risk of having a lower-limb amputation is increasing. Comprehensive rehabilitation is vital to mitigate the negative impact that a lower-limb amputation has on a person. Objective: To explore the barriers and facilitators to accessing rehabilitation experienced by persons with lower-limb amputations in a rural setting. Study Design: A qualitative descriptive approach was used to collect and analyse data. Methods: Data were collected from 11 conveniently sampled participants from three sub-district hospitals in the rural iLembe district, Kwa-Zulu Natal, South Africa. Data were collected using semi-structured interviews to explore the barriers and facilitators perceived by persons with lower-limb amputations in a rural region. Results: The three main barriers identified in this study were environmental factors, financial constraints and impairments. These barriers negatively impacted the participant’s utilisation of rehabilitation. The two main facilitators identified were environmental facilitators and personal factors which aided participant’s utilisation of rehabilitation. Conclusion: Access to rehabilitation was mainly hindered by the challenges utilising transport to the hospital, while self-motivation to improve was the strongest facilitator to utilising rehabilitation. Clinical relevance Rehabilitation is essential in preparation for prosthetic fitting. If a person cannot access rehabilitation services, they will remain dependent on caregivers. Highlighting the challenges to utilisation of rehabilitation in rural areas can assist to reduce these barriers and improve the functional status of persons with lower-limb amputations.
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Majstorovic, Biljana, and Mladen Pesta. "Factors predicting rehabilitation outcome in patients after unilateral transtibial amputation due to peripheral vascular disease." Vojnosanitetski pregled 77, no. 4 (2020): 357–62. http://dx.doi.org/10.2298/vsp170318085m.
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Background/Aim. The primary rehabilitation in the prosthetic phase after amputation of lower extremities is of great importance for the improvement of the activities of daily living (ADLs) of persons with amputation and their successful social reintegration. The aim of this study was to examine the influence of independent predictors (age, gender, duration of rehabilitation, time between the amputation and the mounting of the prosthesis) on the success of the primary rehabilitation in the prosthetic phase after amputation of lower extremities. Methods. This retrospective clinical study included patients who underwent the primary rehabilitation in the prosthetic phase at the Institute for Physical Medicine and Rehabilitation ?Dr Miroslav Zotovic?, Banja Luka, in 2015. A total of 75 patients with unilateral transtibial amputation were included. Etiologically, these transtibial amputations occurred as a consequence of vascular complications of diabetes mellitus or peripheral occlusive arterial disease. Evaluation of the success of rehabilitation was performed at the end of the primary rehabilitation in the prosthetic phase and 3 months after the end of the treatment by means of K-levels classification system and Locomotor Capabilities Index (LCI) scale. Depending on the distribution of data, univariate and multivariate multiple regression analysis, post hoc Mann-Whitney test, Spearman?s correlation coefficient and Wilcoxon test were used for statistical analysis. Statistical significance of the found differences was set at p < 0.05. Results. A total of 75 patients, 55 (73.33%) men and 20 (26.67%) women, were included in this clinical trial. Average age of all participants was 63.5 ? 9.06 years, 61.8 ? 9.34 years for males and 68.1 ? 6.4 for females (p < 0.01). Average duration of rehabilitation was 27.69 ? 7.39 days in men and 33.9 ? 6.89 days in women (p < 0.01). Male patients had better functional results compared to females obtained by all analysed outcome measures (p < 0.01). Younger patients achieved better results, with the degree of statistical significance ranging between p < 0.05 and p < 0.001. The time from the amputation to the mounting of prosthesis and the duration of rehabilitation had no influence on the rehabilitation outcome. Conclusion. The present study identified age and gender of patients as relevant independent predictors of the success of rehabilitation. Although it was initially expected, this clinical trial did not prove the importance of the time from the amputation to the start of the primary rehabilitation in the prosthetic phase. In the future research other independent predictive factors, such as comorbidities, first and foremost cardiovascular diseases, medication, laboratory parameters and mental status, should be taken into account.
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Vishwakarma, Nishish, Babar Rehmani, Atul Agarwal, and Jitendra Prasad Ray. "Reamputation rates, morbidity and rehabilitation after lower limb amputations." International Surgery Journal 6, no. 4 (March 26, 2019): 1274. http://dx.doi.org/10.18203/2349-2902.isj20191262.
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Background: This study attempted to document the indications for lower limb amputation (LLA) and its outcomes especially the wound healing problems, reamputations and subsequent use of prosthesis for mobilization in Indian population.Methods: This observational study included 92 patients over a period of 18 months. Indications, level of LLA, morbidity and reamputation rates after LLA were recorded. Stump status, wound healing and other morbidity was followed over period of one month. The use of prosthesis and level of mobility were assessing in follow-up over a period of six months.Results: There were total 109 LLA in 92 patients as some of these patients had to undergo revision of amputation stump at a higher level. Atherosclerosis (29.3%) was the main cause for LLA. Age group 35-55 years and male patients were most commonly needed LLA. Total 64.13% patients developed post-operative wound infection and 18.4% patients underwent reamputation. E. coli and Staphylococcus were the most common organism cultured from the infected surgical site. Conversion of below knee amputation (BKA) to above knee amputation (AKA) was the most frequent reamputation and atherosclerosis was the leading cause. According to final level LLA, 54 had major amputations (above ankle joint), only 37% were using a prosthesis whereas majority of patients were dependent on crutches/walker.Conclusions: Patients of atherosclerosis and trauma had a higher frequency of reamputations. Only 37% of major LLA opted for prosthesis whereas majority of patients mobilize by other means like crutches or walker.
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Ebskov, B. "Relative mortality and long term survival for the non-diabetic lower limb amputee with vascular insufficiency." Prosthetics and Orthotics International 23, no. 3 (December 1999): 209–16. http://dx.doi.org/10.3109/03093649909071636.
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On a well defined non-diabetic amputation group with vascular insufficiency consisting of 10,191 amputations during the period 1982 to 1992 the Standard Mortality Rate (SMR) and the long term survival (Kaplan-Meyer) were analysed. The SMR for the total group was 8.6 (8.4–8.9) times the expected mortality the first year after amputation, decreasing to 3.2 (3.3–3.4) the second year. SMR in relation to age, gender and level of amputation was analysed. In the long term survival studies the median survival time (50% survival) for the total group was 1.8 years. Significant relation was found between the long term survival and gender, age and level of amputation.
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Choi, Youngrak. "Rehabilitation of patients after diabetic foot amputation." Journal of the Korean Medical Association 64, no. 8 (August 10, 2021): 537–42. http://dx.doi.org/10.5124/jkma.2021.64.8.537.
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Background: Diabetic foot is a diabetes-related complication that often requires amputation due to ulcer, necrosis, infection, and wound healing problems. Amputation decreases ambulation ability and worsens the patient’s general condition. Thus, active gait training is important after amputation.Current Concepts: The level of amputation depends on the anatomical position, for example, toe amputation and transfemoral amputation. The impairment of ambulatory function is also determined by the position of amputation. Continuous rehabilitation exercise is encouraged for ambulation before surgery. Wound management and pain control are needed for early rehabilitation exercise after surgery. The maturation of the amputation stump is especially important and needed for prosthesis wearing. If the general condition of the patient permits, muscle strengthening exercises, joint range of motion exercises, and ambulation exercises should be started as soon as possible.Discussion and Conclusion: Sufficient understanding of functional decline after amputation is required. The clear goal of ambulation should be set in consideration of the patient’s general condition and ability to walk before surgery. The ultimate goal of amputation is not only to remove necrosis, ulcers, and infected tissues but also to restore ambulatory function. Thus, expertise and significant effort before and after surgery are required.
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Geertzen, J. H. B., H. J. Hoekstra, A. Elzinga, and J. S. Rietman. "Rehabilitation management for a patient with a radical forequarter amputation with chest wall resection." Prosthetics and Orthotics International 22, no. 3 (December 1998): 254–57. http://dx.doi.org/10.3109/03093649809164492.
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Since the improvement of surgical oncological operative procedures, anaesthesiology and intensive care facilities, forequarter amputations are being performed with increasing frequency and decreasing morbidity and mortality. This clinical note reports the rehabilitation and prosthetic management of a patient with an extensive forequarter amputation including pneumectomy.
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Devinuwara, Kanch, Agata Dworak-Kula, and Rory J. O'Connor. "Rehabilitation and prosthetics post-amputation." Orthopaedics and Trauma 32, no. 4 (August 2018): 234–40. http://dx.doi.org/10.1016/j.mporth.2018.05.007.
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PINZUR, MICHAEL S., GERALDINE GRAHAM, and HELEN OSTERMAN. "Psychologic Testing in Amputation Rehabilitation." Clinical Orthopaedics and Related Research &NA;, no. 229 (April 1988): 236???240. http://dx.doi.org/10.1097/00003086-198804000-00033.
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Kent, R., and N. Fyfe. "Effectiveness of rehabilitation following amputation." Clinical Rehabilitation 13, no. 1 (February 1, 1999): 43–50. http://dx.doi.org/10.1191/026921599676538002.
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Mueller, Michael J., and David R. Sinacore. "Rehabilitation Factors Following Transmetatarsal Amputation." Physical Therapy 74, no. 11 (November 1, 1994): 1027–33. http://dx.doi.org/10.1093/ptj/74.11.1027.
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Freire, J., C. Schiappacasse, A. Heredia, J. D. Martina, and J. H. B. Geertzen. "Functional results after a Krukenberg amputation." Prosthetics and Orthotics International 29, no. 1 (April 2005): 87–92. http://dx.doi.org/10.1080/17461550500069539.
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This case report presents a 51 year old female patient who had a train accident in 1999. She suffered bilateral trans-tibial and bilateral trans-radial amputations. In this paper, the evolution of the right transradial amputation where eventually a Krukenberg procedure was performed, is described as is its good functional outcome after rehabilitation treatment. After this first procedure the patient also asked for the Krukenberg procedure for her left arm.
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Ender, Ender, Machner, and Neumann. "Die Amputation der durchblutungsgestörten Extremität aus der Sicht des Orthopäden." Vasa 38, Supplement 74 (February 1, 2009): 66–71. http://dx.doi.org/10.1024/0301-1526.38.s74.66.
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Trotz aller therapeutischen Fortschritte in der Behandlung von arteriellen Durchblutungsstörungen der unteren Extremität müssen jährlich mehrere zehntausend Amputationen in diesem Bereich durchgeführt werden. Die vollzogene Amputation ist nicht das Ende der Behandlung sondern sie steht am Anfang der Rehabilitation des Patienten. Ausschlaggebende Kriterien für eine erfolgreiche Rehabilitation sind die Qualität des Extremitätenstumpfes, die Sofort- und Frühversorgung und eine adäquate Prothesenversorgung.
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Gallagher, P., and M. MacLachlan. "Positive meaning in amputation and thoughts about the amputated limb." Prosthetics and Orthotics International 24, no. 3 (December 2000): 196–204. http://dx.doi.org/10.1080/03093640008726548.
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The majority of research conducted on the aftermath of amputation understandably concerns itself with its most distressing aspects. This research aimed to explore whether and how people think about their amputated limb, and whether and if they considered anything good had emerged from their amputation. One hundred and four (104) people completed the Trinity Amputation and Prosthesis Experience Scales (TAPES) and two openended questions. The majority of participants were young and had traumatic amputations. Fiftysix percent (56%) of people thought about their amputated limb. People with bilateral or a transfemoral amputation were more likely to think about their amputated limb than people with a transtibial amputation. Fortyeight percent (48%) considered that something good had happened as a result of the amputation. Furthermore, finding positive meaning was significantly associated with more favourable physical capabilities and health ratings, lower levels of Athletic Activity Restriction and higher levels of Adjustment to Limitation. Future research and clinical implications are discussed.
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Sooriakumaran, Sellaiah, Maggie Uden, Sarah Mulroy, David Ewins, and Thomas Collins. "The impact a surgeon has on primary amputee prosthetic rehabilitation: A survey of residual lower limb quality." Prosthetics and Orthotics International 42, no. 4 (February 26, 2018): 428–36. http://dx.doi.org/10.1177/0309364618757768.
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Background: Substantial improvements have been perceived in surgical results following major lower limb amputation, but there remains observed variation in amputation quality for patients referred for prosthetic rehabilitation from different hospitals. Objectives: To assess various elements that influence residual limb quality and evaluate their impact on progress through initial prosthetic rehabilitation and mobility outcome after rehabilitation. Study design: Clinical survey. Methods: A revised 10-item residual limb scoring system was used to survey a succession of 95 primary amputees with transtibial and transfemoral amputations (100 residual limbs) presenting for rehabilitation. Results: The majority of residual limbs scored highly, supporting the perception of generally good amputation quality. There were significant differences in average residual limb scores between some hospitals. The overall scores showed weak or minimal correlation to progress through rehabilitation and mobility outcome but residual limbs scoring higher in seven of the items of the score showed significant advantages in key aspects of progress or mobility at discharge. Conclusion: There is need for continued collaboration between surgeons and rehabilitation centres to ensure consistent high standards. The revised residual limb score used in this survey needs further refinement for future use. Clinical relevance Residual limb quality is an important component influencing prosthetic rehabilitation. This survey of residual limbs at one Rehabilitation Centre suggests encouragingly good surgical results but highlights differences between hospitals. A particular issue is the need for effective collaboration between surgeons and prosthetic rehabilitation professionals to optimise residual limb preparation.
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Knowlton, Lisa Marie, James E. Gosney, Smita Chackungal, Eric Altschuler, Lynn Black, Frederick M. Burkle, Kathleen Casey, et al. "Consensus Statements Regarding the Multidisciplinary Care of Limb Amputation Patients in Disasters or Humanitarian Emergencies: Report of the 2011 Humanitarian Action Summit Surgical Working Group on Amputations Following Disasters or Conflict." Prehospital and Disaster Medicine 26, no. 6 (December 2011): 438–48. http://dx.doi.org/10.1017/s1049023x12000076.
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AbstractLimb amputations are frequently performed as a result of trauma inflicted during conflict or disasters. As demonstrated during the 2010 earthquake in Haiti, coordinating care of these patients in austere settings is complex. During the 2011 Humanitarian Action Summit, consensus statements were developed for international organizations providing care to limb amputation patients during disasters or humanitarian emergencies. Expanded planning is needed for a multidisciplinary surgical care team, inclusive of surgeons, anesthesiologists, rehabilitation specialists and mental health professionals. Surgical providers should approach amputation using an operative technique that optimizes limb length and prosthetic fitting. Appropriate anesthesia care involves both peri-operative and long-term pain control. Rehabilitation specialists must be involved early in treatment, ideally before amputation, and should educate the surgical team in prosthetic considerations. Mental health specialists must be included to help the patient with community reintegration. A key step in developing local health systemsis the establishment of surgical outcomes monitoring. Such monitoring can optimizepatient follow-up and foster professional accountability for the treatment of amputation patients in disaster settings and humanitarian emergencies.
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Graham, L. E., and R. C. Parke. "The Northern Ireland Troubles and limb loss: a retrospective study." Prosthetics and Orthotics International 28, no. 3 (December 2004): 225–29. http://dx.doi.org/10.3109/03093640409167754.
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The Troubles in Northern Ireland have now lasted 34 years. Divisions and strife between the opposing loyalist and republican communities, and between the communities and the security forces, have led to thousands of deaths and injuries. The violence has often been indiscriminate injuring and killing totally innocent people. Staff at the Regional Disablement Services at Musgrave Park Hospital, Belfast have had the responsibility for helping to rehabilitate those who have suffered limb loss, both civilians and security forces personnel. In this study the authors present patient demographics for those survivors, referred for prosthetic fitting, who have sustained limb amputations as a result of the Troubles from 1969 to 2003, with the cause of injury, resulting levels of amputation, associated injuries, time to first prosthetic fitting and reason for any delay in fitting identified. One hundred and twenty-nine (129) patients sustained amputations, 110 male and 19 female with an age range at the time of injury from 7 to 60 years. Seventy-two (72) were civilian. Ninety-three (93) underwent immediate amputation, the most frequent level of amputation being trans-femoral. Delayed healing of deep wounds was the most common reason for delayed amputation; other causes were chronic osteomyelitis, malunited fractures and failed arthrodesis, often associated with chronic pain. Ninety-two (92) patients required amputation of one limb or part thereof, 35 required amputation of 2 limbs and 2 underwent triple amputation. Three (3) patients lost both hands. Sixty seven percent (67%) had other associated physical injuries. Thirty-two (32) patients had a delay of 6 months or more in fitting a prosthesis. The most common cause of injury was the car bomb.
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Hallman, Taylor, Amina El Ayadi, Deepak K. Ozhathil, George Golovko, Juquan Song, and Steven E. Wolf. "20 Chronic Cardiovascular Dysfunction Following Lower Extremity Amputation in Burn Patients." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S18—S19. http://dx.doi.org/10.1093/jbcr/irab032.025.
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Abstract Introduction Long-term chronic cardiovascular dysfunction is a well-reported outcome in patients who have suffered severe burns associated with diminished muscle mass and hypermetabolism. Devastating burn injuries sometimes warrant extremity amputation to preserve life over limb. A lower extremity amputation can exacerbate the risk of burn-related sequelae due to prolonged recovery and reduced mobility. We queried a large multi-institutional national database to investigate whether lower extremity amputations in those with severe burns were associated with increased incidence of chronic myocardial dysfunction syndromes. Methods We accessed the TriNetX Global Health Research Network and queried ICD-10 codes for burn injuries (T20-25, T30-32) across 41 participating health care organizations. Comparative cohorts of patients who underwent lower extremity amputations and those who did not were identified. A matched case-control analysis of these cohorts accounting for age and gender matching was compared for the subsequent diagnosis of chronic cardiac dysfunction syndromes (I50.22, I50.32, I50.42, I50.812). Results A total of 347,156 patients did not undergo lower extremity amputation, and their demographics showed a mean age of 38 years, 54% males, 60% white and 18% African American. In contrast, 1,535 patients underwent lower extremity amputation with a mean age was 59 years, 73% were male, 60% white and 24% African American. Burn patients who underwent amputations showed a comparative increased risk of 5.77% (p < 0.0001) for developing of chronic cardiac dysfunction compared to those who did not undergo amputations (RR 3.512, 95% CI: 2.39–5.16). One year following injury this comparative risk diminished to 3.45% (p < 0.0001; RR 3.14, 95% CI: 1.96–5.04). The difference in risk was not significant 3 years after burn injury (0.538%, p = 0.2163, RR 1.54, 95% CI: 0.77–3.09). Conclusions Patients who underwent amputations after severe burn are at increased risk of developing chronic cardiac dysfunction compared to those that did not undergo amputation; the significance appears to diminish with time. Further research is indicated to elucidate the mechanism for this relationship.
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Osmani-Vllasolli, Teuta, Hajrije Hundozi, Nikola Orovcanec, Blerim Krasniqi, and Ardiana Murtezani. "Rehabilitation outcome following war-related transtibial amputation in Kosovo." Prosthetics and Orthotics International 38, no. 3 (July 17, 2013): 211–17. http://dx.doi.org/10.1177/0309364613494084.
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Background:Previous literature has suggested that age, level of amputation, residual limb length, comorbidities, mental disorders, and cause of amputation can affect the ability to successfully ambulate with prosthesis.Objectives:The objective of this study was to analyze the predictors that affect the rehabilitation outcome of war-related transtibial amputees and the relationship of these factors with ambulation ability after prosthetic fitting.Study design:Retrospective observational study.Methods:We reviewed the records of 69 war-related transtibial amputees. The rehabilitation outcome was analyzed according to the grade of rehabilitation summarized in three grades. Multiple logistic regression analysis was used to determine the odds of achieving the first rehabilitation grade.Results:The majority of patients with transtibial amputations achieved the first grade of rehabilitation (59.4%). The factors that significantly influenced the achievement of the first grade of rehabilitation were age and absence of posttraumatic stress disorder. For every 1-year increase in patient age, the odds of achieving first grade of rehabilitation decreased by a factor of 0.9. Patients without posttraumatic stress disorder had 12.9 greater odds of achieving the first rehabilitation grade compared to patients with posttraumatic stress disorder.Conclusion:Achievement of the first grade of rehabilitation among war-related transtibial amputees is dependent on patient age and the absence of posttraumatic stress disorder.Clinical relevanceUnderstanding the factors that may affect the rehabilitation outcome of war-related amputees could lead to a more specific organization of the rehabilitation, especially in a country that has recently been involved in war. This is the first study to focus on determinants of prosthetic rehabilitation in these patients.
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Fortington, Lauren V., Gerardus M. Rommers, Klaas Postema, Jaap J. van Netten, Jan HB Geertzen, and Pieter U. Dijkstra. "Lower limb amputation in Northern Netherlands: Unchanged incidence from 1991–1992 to 2003–2004." Prosthetics and Orthotics International 37, no. 4 (January 17, 2013): 305–10. http://dx.doi.org/10.1177/0309364612469385.
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Background:Investigating population changes gives insight into effectiveness and need for prevention and rehabilitation services. Incidence rates of amputation are highly varied, making it difficult to meaningfully compare rates between studies and regions or to compare changes over time.Study Design:Historical cohort study of transtibial amputation, knee disarticulation, and transfemoral amputations resulting from vascular disease or infection, with/without diabetes, in 2003–2004, in the three Northern provinces of the Netherlands.Objectives:To report the incidence of first transtibial amputation, knee disarticulation, or transfemoral amputation in 2003–2004 and the characteristics of this population, and to compare these outcomes to an earlier reported cohort from 1991 to 1992.Methods:Population-based incidence rates were calculated per 100,000 person-years and compared across the two cohorts.Results:Incidence of amputation was 8.8 (all age groups) and 23.6 (≥45 years) per 100,000 person-years. This was unchanged from the earlier study of 1991–1992. The relative risk of amputation was 12 times greater for people with diabetes than for people without diabetes.Conclusions:Investigation is needed into reasons for the unchanged incidence with respect to the provision of services from a range of disciplines, including vascular surgery, diabetes care, and multidisciplinary foot clinics.Clinical relevanceThis study shows an unchanged incidence of amputation over time and a high risk of amputation related to diabetes. Given the increased prevalence of diabetes and population aging, both of which present an increase in the population at risk of amputation, finding methods for reducing the rate of amputation is of importance.
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Al-Worikat, Abdel Fattah, and Walid Dameh. "Children with limb deficiencies: Demographic characteristics." Prosthetics and Orthotics International 32, no. 1 (January 1, 2008): 23–28. http://dx.doi.org/10.1080/03093640701517083.
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The aim of this study is to determine the demographic data for amputations in children in relation of age, sex, level and cause of amputation. Data were collected from the records of amputees who attended the prosthetic clinic at the Royal Rehabilitation Center, King Hussein Medical Centre, Jordan, between 1 January 1995 and 31 December 2005. Demographic data (age, sex, level and cause of amputation) were analyzed. Some120 children with different levels of amputation were included with mean age of 6.2 years. There were 64 (53.3%) males and 56 (46.7%) females. Male to female ratio was 1.15:1. The dominant level of amputation was trans-radial in 10 patients (15.62%) in the upper limb and trans-tibial in 18 patients (28.12%) in the lower limb. The dominant cause of amputation was congenital deficiency in 56 patients (46.67%) followed by trauma in 48 (40%). The results of this study presented greater similarities to others in the literature, congenital limb deficiency being the dominant cause of amputation in children. This study helps in planning the needs for materials and budgets for the treatment of amputee children in Jordan.
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Johannesson, A., G. U. Larsson, and T. Öberg. "From major amputation to prosthetic outcome: a prospective study of 190 patients in a defined population." Prosthetics and Orthotics International 28, no. 1 (April 2004): 9–21. http://dx.doi.org/10.3109/03093640409167920.
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In this prospective study, the overall treatment and outcome of patients that underwent major lower limb amputation in a defined population is described. The study was performed over a five year period in the Health Care District of North-East Skåne, Sweden. Some 190 patients, permanent inhabitants of the Health Care District, underwent major lower limb amputation. Sixteen (16) of these patients had amputations before the study started and went through late second leg amputation during the period. One hundred and seventy four (174) patients had primary major amputation. Seventy nine (79) were men and 95 were women, with a median age of 81. The re-amputation rate was 17% although the primary knee preservation ratio was as high as 3.0:1. Rigid dressing was the standard method following trans-tibial amputation and was used for 5–7 days. ICEROSS∗ silicone liner was used for compression therapy in 90% of all cases that resulted in delivery of a prosthesis. Prostheses were delivered to 43% of all patients with primary amputations. These patients spent a median of 13 days at the orthopaedic clinic, 55 days at the rehabilitation unit. Pressure casting was used as a standard method in the production of the prosthetic socket. ICEX∗ carbon-fibre socket was used in 52%. New procedures, treatments and techniques were introduced, standardised and evaluated whilst the routines in the hospital were reorganised. In this way, a system has been implemented that better guarantees the outcome of the whole procedure and the service received by this category of patients.
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Davie-Smith, Fiona, Lorna Paul, Natalie Nicholls, Wesley P. Stuart, and Brian Kennon. "The impact of gender, level of amputation and diabetes on prosthetic fit rates following major lower extremity amputation." Prosthetics and Orthotics International 41, no. 1 (July 9, 2016): 19–25. http://dx.doi.org/10.1177/0309364616628341.
Full textAbstract:
Background: Diabetes mellitus is a leading cause of major lower extremity amputation. Objective: To examine the influence of gender, level of amputation and diabetes mellitus status on being fit with a prosthetic limb following lower extremity amputation for peripheral arterial disease. Study design: Retrospective analysis of the Scottish Physiotherapy Amputee Research Group dataset. Results: Within the cohort with peripheral arterial disease ( n = 1735), 64% were men ( n = 1112) and 48% ( n = 834) had diabetes mellitus. Those with diabetes mellitus were younger than those without: mean 67.5 and 71.1 years, respectively ( p < 0.001). Trans-tibial amputation:trans-femoral amputation ratio was 2.33 in those with diabetes mellitus, and 0.93 in those without. A total of 41% of those with diabetes mellitus were successfully fit with a prosthetic limb compared to 38% of those without diabetes mellitus. Male gender positively predicted fitting with a prosthetic limb at both trans-tibial amputation ( p = 0.001) and trans-femoral amputation ( p = 0.001) levels. Bilateral amputations and increasing age were negative predictors of fitting with a prosthetic limb ( p < 0.001). Diabetes mellitus negatively predicted fitting with a prosthetic limb at trans-femoral amputation level ( p < 0.001). Mortality was 17% for the cohort, 22% when the amputation was at trans-femoral amputation level. Conclusion: Of those with lower extremity amputation as a result of peripheral arterial disease, those with diabetes mellitus were younger, and more had trans-tibial amputation. Although both age and amputation level are good predictors of fitting with a prosthetic limb, successful limb fit rates were no better than those without diabetes mellitus. Clinical relevance This is of clinical relevance to those who are involved in the decision-making process of prosthetic fitting following major amputation for dysvascular and diabetes aetiologies.