Abstract
Objective: to examine the hypothesis that functional outcomes following major lower-extremity trauma sustained in the military would be similar between patients treated with amputation and those who underwent limb salvage. Methods: this is a retrospective cohort study of 324 service members deployed to Afghanistan or Iraq who sustained a lower-limb injury requiring either amputation or limb salvage involving revascularization, bone graft/bone transport, local/free flap coverage, repair of a major nerve injury, a complete compartment injury/compartment syndrome. The Short Musculoskeletal Function Assessment (SMFA) questionnaire was used to measure overall function. Standard instruments were used to measure depression (the Center for Epidemiologic Studies Depression Scale), posttraumatic stress disorder (PTSD Checklist-military version), chronic pain (Chronic Pain Grade Scale), and engagement in sports and leisure activities (Paffenbarger Physical Activity Questionnaire). The outcomes of treatment were compared by using regression analysis with adjustment for age, time until the interview, military rank, upper-limb and bilateral injuries, social support, and intensity of combat experiences. Results: overall response rates were modest (59.2 %) and significantly different between those who underwent amputation (64.5 %) and those treated with limb salvage (55.4 %) (p = 0.02). Also, 38.3 % screened positive for depressive symptoms and 17.9 %, for posttraumatic stress disorder (PTSD). One-third (34.0 %) were not working, on active duty, or in school. After adjustment for covariates, participants with an amputation had better scores in all SMFA domains compared with those whose limbs had been salvaged (p < 0.01). They also had a lower likelihood of PTSD and a higher likelihood of being engaged in vigorous sports. Conclusions: major lower-limb trauma sustained in the military results in significant disability. Service members who undergo amputation appear to have better functional outcomes than those who undergo limb salvage. Caution is needed in interpreting these results as there was a potential for selection bias.
Highlights
Extremity trauma resulting from high-energy explosives in Iraq and Afghanistan is common; 54 % of evacuated wounded service members have extre mity injuries
Results from the Lower Extremity Assessment Project (LEAP) suggest that the functional outcomes of reconstruction and amputation are similar in civilians being treated for major lower-extremity trauma [3,4,5,6]
The objective of this study was to examine functional outcomes and disability following major lower-extremity trauma sustained in the military and to compare the outcomes between patients treated with amputation and those treated with limb salvage
Summary
Extremity trauma resulting from high-energy explosives in Iraq and Afghanistan is common; 54 % of evacuated wounded service members have extre mity injuries. Results from the Lower Extremity Assessment Project (LEAP) suggest that the functional outcomes of reconstruction and amputation are similar in civilians being treated for major lower-extremity trauma [3,4,5,6]. Regardless of the type of treatment, LEAP outcomes were not optimal, with one-half of injured civilians reporting high levels of disability. These results may not be gene ralizable to the military. The objective of this study was to examine functional outcomes and disability following major lower-extremity trauma sustained in the military and to compare the outcomes between patients treated with amputation and those treated with limb salvage. On the basis of existing civilian studies, we hypothesized that the outcomes are similar for the two treatment groups
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