Functional Gait Analysis Before and After Delayed Military Trauma-Related Amputation: A Report of Three Cases.

Abstract

The current conflicts in Iraq and Afghanistan have produced a large number of service members with severe combat-related injuries. Eighty-two percent of service members with combat-related injuries have sustained extremity trauma, which accounts for 54% of wounds overall1. Of all the lower-extremity amputations performed at military treatment facilities, approximately 13% (125 of 975) were the result of delayed or “elective” procedures2. Recent studies have shown that the outcomes of extensive salvage procedures for severely injured limbs are not necessarily definitive in a nonmilitary population3 and that early amputation can be preferable to limb salvage in many such instances3-12. Some military and nonmilitary population studies have considered a delayed amputation as occurring within as little as twenty-four hours postinjury, while other studies have cited a range over years4,13,14. Up to 15% of combat-related amputations have occurred later than twelve weeks postinjury, and the military medical community has adopted this as a reasonable timeframe during which initial operative efforts at limb salvage can be attempted2,14. Given the incidence of trauma-related amputation in the active duty military population, as well as the likely underreported frequency of similar scenarios in civilian trauma settings3,8,15-17, the goal of this report is to provide an analysis of gait in combat-injured patients before and after delayed amputation. Our institutional review board approved the retrospective review of the data presented in this manuscript. The three patients included in this case series were informed that data would be submitted for publication, and they all gave consent. Case 1. A forty-one-year-old male U.S. Navy navigator was involved in a midair collision and was ejected from his aircraft. Upon landing, he sustained a Gustilo …