Indications and Pattern of Limb Amputation: A Tertiary Hospital Experience, South-South, Nigeria

Abstract

The aim of this paper was to study the indications and patterns of limb amputations in the University of Calabar Teaching Hospital, a retrospective study of 142 limb amputations performed in patients admitted to the University of Calabar Teaching Hospital, South-South, Nigeria. Data was obtained from theater records and the medical record department of the hospital after due ethical approval. The data spanned a period of 10 years (from January 2004 to December 2014). A total of 142 patients were seen. The age ranged from 8 to 87 years with a mean age of 46 years ± SD 17.9 years and a male to female ratio of 2.3:1. Adults accounted for 95.8% while 4.2% were children. Emergency procedures accounted for 47.9% of the amputations. Diabetic foot gangrene was the major cause of lower limb amputation 91 (64.1%), trauma accounted for 27 (19%) of these, 15.5% were due to road traffic accidents, and 3.5% were cases of gunshot injuries. Tumors and limb ischemia accounted for 9.2 and 2.8%, respectively. Electrical injury, industrial accidents, and ischemic limbs from tight tourniquet splints by traditional bonesetters were the common causes of upper limb amputations. Most of the amputations were on the lower limb (83.7%) with the left lower limb accounting for 47.8% and the right lower limb accounting for 35.9% .Upper limb amputations accounted for 15.4% with right and left upper limbs being 8.4 and 7.0%, respectively .Only one patient had bilateral lower limb amputation(0.7%). For the levels of amputation, the majority were below knee 54 (38%) followed by above elbow 38 (26.8%) amputations (Figure 1); others were ray amputation of the foot and hand as 28 (19.7%) and 8 (5.6%), respectively. The least was below elbow amputation 6 (4.2%). The study showed that 96% of the causes were potentially preventable, and that establishment of a prosthetic-orthotic center is needed in this part of the country.