Major Upper Extremity Amputation

Non-traumatic upper extremity amputations are an increasing concern with the rising prevalence of diabetes mellitus. To ascertain the risk factors and mortality rates for these amputations, the demographic information, amputation history, comorbidities and clinical outcomes of 140 patients who underwent non-traumatic upper extremity amputations between 1 January 2004 and 31 October 2017 were studied. Correlations were assessed using Cochran-Armitage chi-squared tests, odds ratios and multivariate binomial logistic regression as appropriate. Diabetes mellitus, coronary artery disease, end-stage renal failure, peripheral arterial disease and prior lower extremity amputation were significant risk factors for multiple upper extremity amputations. One-year, 2-year and 5-year mortality rates were 12%, 15% and 38%, respectively, following first upper extremity amputation. The risk factors for upper extremity amputations correspond with those for lower extremity amputations, comprising mainly diabetes mellitus and its related comorbidities. The mortality rates for non-traumatic upper extremity amputations highlight their significant burden on patients. Level of evidence: III

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Impact of traumatic upper-extremity amputation on the outcome of injury caused by an antipersonnel improvised explosive device

Canadian Journal of Surgery ◽

10.1503/cjs.014518 ◽

2018 ◽

Vol 61 (6 Suppl 1) ◽

pp. S203-S207

Author(s):

Shane A. Smith ◽

Mark P. DaCambra ◽

Vivian C. McAlister

Keyword(s):

Upper Extremity ◽

Improvised Explosive Device ◽

Explosive Device ◽

Improvised Explosive ◽

Extremity Amputation

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Neurorehabilitation in Adults With Traumatic Upper Extremity Amputation: A Scoping Review

Neurorehabilitation and Neural Repair ◽

10.1177/15459683211070277 ◽

2021 ◽

pp. 154596832110702

Author(s):

Jake Rydland ◽

Stephanie Spiegel ◽

Olivia Wolfe ◽

Bennett Alterman ◽

John T Johnson ◽

...

Keyword(s):

Upper Extremity ◽

Upper Limb ◽

Current Literature ◽

Scoping Review ◽

Neural Mechanisms ◽

Limb Amputation ◽

Future Research ◽

Prosthetic Devices ◽

Scoping Reviews ◽

Extremity Amputation

Background Most of the current literature around amputation focuses on lower extremity amputation or engineering aspects of prosthetic devices. There is a need to more clearly understand neurobehavioral mechanisms related to upper extremity amputation and how such mechanisms might influence recovery and utilization of prostheses. Objective This scoping review aims to identify and summarize the current literature on adult traumatic upper limb amputation in regard to recovery and functional outcomes and how neuroplasticity might influence these findings. Methods We identified appropriate articles using Academic Search Complete EBSCO, OVID Medline, and Cochrane databases. The resulting articles were then exported, screened, and reviewed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines. Results Eleven (11) studies met the study criteria. Of these studies, 7 focused on sensory involvement, 3 focused on neuroplastic changes post-amputation related to functional impact, and 1 study focused on motor control and learning post-amputation. Overall, these studies revealed an incomplete understanding of the neural mechanisms involved in motor rehabilitation in the central and peripheral nervous systems, while also demonstrating the value of an individualized approach to neurorehabilitation in upper limb loss. Conclusions There is a gap in our understanding of the role of neurorehabilitation following amputation. Overall, focused rehabilitation parameters, demographic information, and clarity around central and peripheral neural mechanisms are needed in future research to address neurobehavioral mechanisms to promote functional recovery following traumatic upper extremity amputation.

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Rehabilitation for Persons with Upper-Extremity Amputation

Orthotics and Prosthetics in Rehabilitation ◽

10.1016/b978-1-4377-1936-9.00031-x ◽

2013 ◽

pp. 814-829

Author(s):

Margaret Wise

Keyword(s):

Upper Extremity ◽

Extremity Amputation

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Kinematic Evaluation of Terminal Devices for Kayaking With Upper Extremity Amputation

JPO Journal of Prosthetics and Orthotics ◽

10.1097/jpo.0b013e31806ada2f ◽

2007 ◽

Vol 19 (3) ◽

pp. 84-90 ◽

Cited By ~ 11

Author(s):

M Jason Highsmith ◽

Stephanie L. Carey ◽

Kip W. Koelsch ◽

Craig P. Lusk ◽

Murray E. Maitland

Keyword(s):

Upper Extremity ◽

Kinematic Evaluation ◽

Extremity Amputation

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Dismounted complex blast injuries

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000342 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0003

Author(s):

Paul Ryan ◽

Claude Anderson ◽

Steven Wilding

Keyword(s):

Lower Extremity ◽

Upper Extremity ◽

The United States ◽

Lower Extremity Amputation ◽

Traumatic Amputation ◽

Amputation Level ◽

Skeletal Injury ◽

Knee Amputation ◽

The Us ◽

Extremity Amputation

Category: Trauma Introduction/Purpose: The United States Medical Corps has continued to evaluate and define the injury patterns of our service members in an effort to prevent injury and improve combat casualty care. The pattern of injury can be predicted by the mechanism of injury. One of the more recently described and studied mechanisms has been coined the ‘dismounted complex blast injury. This injury pattern involves traumatic amputation of at least one leg with a second injury involving another extremity in addition to an injury to either the pelvis, the abdomen, or the urogenital region. The purpose of this study was to better define and describe the injuries occurring to the non amputated extremity. Methods: This is a retrospectively review of data from the US and UK Joint Theater Trauma Registries (JTTR) of consecutive patients admitted to the UK Role 3 hospital at Camp Bastion, Afghanistan, from January 1, 2009, to February 29, 2012. Data was obtained from the US JTTR (Joint Theatre Trauma Registry). Each patient was assigned an Injury Severity Score (ISS) and an Abbreviated Injury Scale (AIS) score. Only those patients with an AIS of 3 or greater (a serious injury) were included. All xrays and CT scans were evaluated by two board certified orthopaedic surgeons and one board certified musculoskeletal radiologist. Fisher’s exact test was used to compare categorical data and binomial logistic regression was be used to compare proportions of types of injuries by traumatic amputation level observed. Results: There were 295 patients with lower extremity injuries identified. 201 had traumatic lower extremity amputations, 140 with bilateral lower extremity amputations, 61 with single leg amputations. The mean age was 23.38 +/-3.77 years. All were male. Below the knee amputation was the most frequent amputation type observed, representing 55.7% of the amputations (29/52), the next most frequent was the through knee amputation representing 25%. The least frequent was the through ankle amputation. The presence of a symes level amputation was associated with an 8.1% increase in the odds of the presence of a skeletal foot injury in the rear lower extremity. There was also an association found between AKA level amputation and skeletal injury in the contralateral upper extremity . Conclusion: This is among the first studies to correlate level of injury and associated musculoskeletal injury for the Afghanistan theater of operations. The results of this data set demonstrate that proximal lower extremity amputation levels are significantly associated with distal upper extremity skeletal injury. In addition, the Symes level of amputation is significantly associated with contralateral foot fractures. Amputation levels proximal to the ankle often present with associated Genitourinary injuries. Unique to this study is the demonstration of a significant association of upper extremity injury with a more proximal lower extremity amputation level .

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