Types Of Amputations Research Articles

Editor's Choice – Analysis of Lower Limb Amputations in Brazil’s Public Health System over 13 Years

Understanding the causes of amputation is crucial for defining health policies that seek to avoid such an outcome, but only a few studies have investigated the epidemiology of patients submitted to amputations in developing countries. The objective of this study was to analyse all lower limb amputations performed in the public health system in Brazil over a 13 year period, evaluating trends in the number of cases, patient demographics, associated aetiologies, hospital length of stay, and in hospital mortality rate. This was a retrospective, population based analysis of all lower limb amputations performed in the Brazilian public health system between 1 January 2008 and 31 December 2020. Using a public database, all types of amputations were selected, defining the number of procedures, their main aetiologies, anatomical level of limb loss, demographic data, regional distribution, and other variables of interest. A total of 633 455 amputations were performed between 2008 and 2020, mostly (55.6%) minor amputations, predominantly in males (67%). There was an upward trend in the number of amputations, determined mainly by the increase in major amputations (50.4% increase in the period). Elderly individuals have the highest rates of amputation. Diabetes mellitus (DM) is becoming the main primary diagnosis associated with amputations over the years. The highest in hospital mortality rate occurred after major amputations and was associated with peripheral arterial disease (PAD). Amputation rates in Brazil show an upward trend. DM is becoming the most frequent associated primary diagnosis, although PAD is the diagnosis most associated with major amputations and in hospital death.

Fall Prevention Training for Service Members With an Amputation or Limb Salvage Following Lower Extremity Trauma.

Recent military conflicts have resulted in a significant number of lower extremity injuries to U.S. service members that result in amputation or limb preservation (LP) procedures. Service members receiving these procedures report a high prevalence and deleterious consequences of falls. Very little research exists to improve balance and reduce falls, especially among young active populations such as service members with LP or limb loss. To address this research gap, we evaluated the success of a fall prevention training program for service members with lower extremity trauma by (1) measuring fall rates, (2) quantifying improvements in trunk control, and (3) determining skill retention at 3 and 6 months after training. Forty-five participants (40 males, mean [±SD] age, 34 ± 8 years) with lower extremity trauma (20 with unilateral transtibial amputation, 6 with unilateral transfemoral amputation, 5 with bilateral transtibial amputation, and 14 with unilateral LP procedures) were enrolled. A microprocessor-controlled treadmill was used to produce task-specific postural perturbations which simulated a trip. The training was conducted over a 2-week period and consisted of six 30-minute sessions. The task difficulty was increased as the participant's ability progressed. The effectiveness of the training program was assessed by collecting data before training (baseline; repeated twice), immediately after training (0 month), and at 3 and 6 months post-training. Training effectiveness was quantified by participant-reported falls in the free-living environment before and after training. Perturbation-induced recovery step trunk flexion angle and velocity was also collected. Participants reported reduced falls and improved balance confidence in the free-living environment following the training. Repeated testing before training revealed that there were no pre-training differences in trunk control. The training program improved trunk control following training, and these skills were retained at 3 and 6 months after training. This study showed that task-specific fall prevention training reduced falls across a cohort of service members with diverse types of amputations and LP procedures following lower extremity trauma. Importantly, the clinical outcome of this effort (i.e., reduced falls and improved balance confidence) can lead to increased participation in occupational, recreational, and social activities and thus improved quality of life.

DEMOGRAPHIC PROFILE AND SURGICAL OUTCOME OF VARIOUS TYPES OF LOWER LIMB AMPUTATIONS'

Background- Amputations is one of the oldest surgery known to mankind.Knowledge on the current trends in amputation is necessary to devise effective preventive measures at community level and to reduce this devastating event. : - 1)To know the incidence of various types of lower-limb amputations in our hospital.2)ToAim And Objectives study the demographic pattern in lower limb amputations in our hospital.3)To know the various risk factors leading to lower limb amputations.4)To know the immediate postoperative complications associated with lower-limb amputations. MATERIALS AND METHODS-This study is a prospective observational study.All patients who have undergone lower limb amputation during 1 year period fulfilling the inclusion criteria were included in the study.Main outcome measures were patient's age, gender, limb affected, indication for amputation, complications, reamputation rate,associated procedure performed, duration of hospital stay and outcome. Of the 96 patients who have underwent lowerResults- limb amputations,the mean age was 57.34 with male: female ratio 3:1.Hospital stay ranged from 3 days to 90days.The presence of comorbidities such as Diabetes Mellitus,Peripheral vascular disease and osteomyelitis were associated with an increased rate of complications postoperatively. The most common complication was stump infection , followed by phantom limb.10 patients died during the hospital stay. Sepsis with MODS was the main cause of death.Reamputation rate in this study was 5%. Diabetic foot and its complications is the leading cause of amputations.ThusConclusion- educating diabetics on proper foot care can prevent diabetic patients from ending up with amputations. Prevention is better than cure.

Characterizing the Gait of People With Different Types of Amputation and Prosthetic Components Through Multimodal Measurements: A Methodological Perspective.

Prosthetic gait implies the use of compensatory motor strategies, including alterations in gait biomechanics and adaptations in the neural control mechanisms adopted by the central nervous system. Despite the constant technological advancements in prostheses design that led to a reduction in compensatory movements and an increased acceptance by the users, a deep comprehension of the numerous factors that influence prosthetic gait is still needed. The quantitative prosthetic gait analysis is an essential step in the development of new and ergonomic devices and to optimize the rehabilitation therapies. Nevertheless, the assessment of prosthetic gait is still carried out by a heterogeneous variety of methodologies, and this limits the comparison of results from different studies, complicating the definition of shared and well-accepted guidelines among clinicians, therapists, physicians, and engineers. This perspective article starts from the results of a project funded by the Italian Worker's Compensation Authority (INAIL) that led to the generation of an extended dataset of measurements involving kinematic, kinetic, and electrophysiological recordings in subjects with different types of amputation and prosthetic components. By encompassing different studies published along the project activities, we discuss the specific information that can be extracted by different kinds of measurements, and we here provide a methodological perspective related to multimodal prosthetic gait assessment, highlighting how, for designing improved prostheses and more effective therapies for patients, it is of critical importance to analyze movement neural control and its mechanical actuation as a whole, without limiting the focus to one specific aspect.

Trends of limb amputation considering type, level, sex and age in Saskatchewan, Canada 2006\u20132019: an in-depth assessment

BackgroundMost epidemiologic reports focus on lower extremity amputation (LEA) caused specifically by diabetes mellitus. However, narrowing scope disregards the impact of other causes and types of limb amputation (LA) diminishing the true incidence and societal burden. We explored the rates of LEA and upper extremity amputation (UEA) by level of amputation, sex and age over 14 years in Saskatchewan, Canada.MethodsWe calculated the differential impact of amputation type (LEA or UEA) and level (major or minor) of LA using retrospective linked hospital discharge data and demographic characteristics of all LA performed in Saskatchewan and resident population between 2006 and 2019. Rates were calculated from total yearly cases per yearly Saskatchewan resident population. Joinpoint regression was employed to quantify annual percentage change (APC) and average annual percent change (AAPC). Negative binomial regression was performed to determine if LA rates differed over time based on sex and age.ResultsIncidence of LEA (31.86 ± 2.85 per 100,000) predominated over UEA (5.84 ± 0.49 per 100,000) over the 14-year study period. The overall LEA rate did not change over the study period (AAPC -0.5 [95% CI − 3.8 to 3.0]) but fluctuations were identified. From 2008 to 2017 LEA rates increased (APC 3.15 [95% CI 1.1 to 5.2]) countered by two statistically insignificant periods of decline (2006–2008 and 2017–2019). From 2006 to 2019 the rate of minor LEA steadily increased (AAPC 3.9 [95% CI 2.4 to 5.4]) while major LEA decreased (AAPC -0.6 [95% CI − 2.1 to 5.4]). Fluctuations in the overall LEA rate nearly corresponded with fluctuations in major LEA with one period of rising rates from 2010 to 2017 (APC 4.2 [95% CI 0.9 to 7.6]) countered by two periods of decline 2006–2010 (APC -11.14 [95% CI − 16.4 to − 5.6]) and 2017–2019 (APC -19.49 [95% CI − 33.5 to − 2.5]). Overall UEA and minor UEA rates remained stable from 2006 to 2019 with too few major UEA performed for in-depth analysis. Males were twice as likely to undergo LA than females (RR = 2.2 [95% CI 1.99–2.51]) with no change in rate over the study period. Persons aged 50–74 years and 75+ years were respectively 5.9 (RR = 5.92 [95% Cl 5.39–6.51]) and 10.6 (RR = 10.58 [95% Cl 9.26–12.08]) times more likely to undergo LA than those aged 0–49 years. LA rate increased with increasing age over the study period.ConclusionThe rise in the rate of minor LEA with simultaneous decline in the rate of major LEA concomitant with the rise in age of patients experiencing LA may reflect a paradigm shift in the management of diseases that lead to LEA. Further, this shift may alter demand for orthotic versus prosthetic intervention. A more granular look into the data is warranted to determine if performing minor LA diminishes the need for major LA.

Pattern and type of amputation and mortality rate associated with diabetic foot in Jeddah, Saudi Arabia: A retrospective Cohort Study

BackgroundDiabetic foot complications constitute a major public health problem worldwide, especially in Jeddah, Saudi Arabia, where the prevalence of diabetes is high. Our study was designed to determine the pattern and type of amputations performed on patients with diabetic foot admitted to a tertiary center in Jeddah, Saudi Arabia; we also aimed to determine the 7-year mortality rate of patients with diabetic foot at the same institution. Materials and methodsThis retrospective study was conducted between January 2013 and September 2020 at a tertiary center in Jeddah, Saudi Arabia. It included all patients previously diagnosed with diabetes mellitus who presented to the hospital with either diabetic foot ulcers or foot gangrene (dry/wet/gas). The medical records of 358 patients were reviewed to acquire information regarding demographics, admission history regarding diabetes and its outcome, medical and surgical history, the level of amputation, and the presence of infection. ResultsAmong the participants, 84.9% underwent amputation, 38.2% underwent minor amputations, 40.1% underwent major amputations, and 21.7% underwent both types of amputation. The most common cause of amputation was infection (50.3%). There were 75 deaths and a 7-year mortality rate of 20%. Low mean hemoglobin and high mean creatinine levels were significantly associated with mortality (p < 0.05). ConclusionEfforts to decrease the risk of amputation and mortality among patients with diabetic foot complications are required. Early detection of the risk factors and intervention in specialist centers with a multidisciplinary approach is essential.

Psychological Rehabilitation on a Patient with Breast and Arm Amputation: A Case Report

We define amputation as a removal of totally or partial part of an organ. Amputations can be caused by chronic diseases as cancer, infection and diabetes, or by a traumatic accident. Where, we discuss the differences between the two types of amputation. This paper is a case report on an amputee patient, the consequences in short e long term. We suggest possible interventions for psychological professionals and multidisciplinary healthcare team. Also, we discuss the lack of academic production about traumatic amputations.

Necrotizing fasciitis, causative agents and management: a five-year retrospective study in two tertiary care hospitals in Central Malaysia.

Necrotizing fasciitis (NF) is a rapidly progressive inflammatory infection of the fascia, with secondary necrosis of the subcutaneous tissues. The severity of the disease depends on the virulence of the organism and host immunity. There is a paucity of reports on the prevalence of NF causing pathogens and management. Retrospective data of patients treated for NF were collected from two tertiary care hospitals in Central Malaysia between January 2014 and December 2018. A total of 469 NF patients were identified. More than half of the NF patients were males (n = 278; 59.28%). The highest number of cases was found among age groups between 30 and 79, with mean age of 56.17. The majority of the NF cases (n = 402; 85.72%) were monomicrobial. Streptococcus spp. (n = 89; 18.98%), Pseudomonas aeruginosa (n = 63; 13.44%) and Staphylococcus spp. (n = 61; 13.01%) were identified as the top three microorganisms isolated. Among the 469 NF cases, 173 (36.8%) were amputated or dead while 296 (63.1%) recovered. Proteus spp. (n = 19; 12.93%), Klebsiella pneumoniae (n = 18; 12.24%) and Escherichia coli (n = 14; 9.52%) were associated with all types of amputations. The most common antibiotic prescribed was unasyn (n = 284; 60.56%), followed by clindamycin (n = 56; 11.94%) and ceftazidime (n = 41; 8.74%). A total of 239 (61.8%) recovered while 148 (38.2%) were either amputated or dead when managed with the unasyn, clindamycin or ceftazidime. This study represents the largest NF cases series in Malaysia highlighting the causative agents and management.

Treatment, rehabilitation and assessment of the quality of life of patients operated for complications of diabetic foot syndrome

Introduction. One of the complications of diabetes mellitus (DM) is diabetic foot syndrome (DFS), which develops in 6–11 % of patients and requires surgical treatment in 40–70 % of them. Various types of amputations and large necrectomies lead to a redistribution of the load on the foot with the development of violations of its support function and deformity. As a result, the soil arises for the development of purulent-necrotic processes, the quality of life of patients decreases. Rehabilitation is an important part of postoperative care. It should be carried out both in the hospital and at the outpatient stage of treatment and is an important measure in preventing complications and improving the quality of life of patients. Aim. To analyze the results of treatment of patients with purulent-necrotic complications (PNC) of DFS, for whom postoperative rehabilitation measures were included in the treatment complex. Materials and methods. The results of treatment of 128 patients operated on for PNC of DFS were studied. The examination and treatment were carried out according to the standards. At the outpatient stage, 45 patients underwent complex rehabilitation using a set of physical exercises in combination with physiotherapy methods of treatment. Determination of the degree of foot deformity was performed using plantography and X-ray of the foot bones. The dynamics of life quality indicators were studied using the Manchester-Oxford foot questionnaire (MOXFQ). Results and discussion. The obtained results showed that in conditions of rehabilitation treatment, after 6 months the number of complications in the main group was less than in the comparison group by 12.6 %, and after a year – by 25 %. The study of the quality of life using the MOXFQ questionnaire 6 months after rehabilitation showed a significant difference in indicators (p &lt; 0.05) between the comparison and the main groups on pain and social interaction scales and the MOXFQ index in general, which indicates a positive effect of the used rehabilitation treatment on the quality life of patients. At the same time, after a year, the reliability of the difference in indicators on all scales and the MOXFQ-index of the main and comparison groups was not revealed, despite the best absolute figures. The result obtained indicates the need for repeated courses of rehabilitation measures in the complex of treatment. Conclusions. Treatment of patients with complications of DFS should be organ-preserving and complex. Treatment should include a set of rehabilitation measures aimed at restoring the motor function and support ability of the foot to prevent its deformation. The use of rehabilitation treatment can reduce the number of complications in the postoperative period and improve the quality of life of patients.

Incidence and Factors Associated With Major Amputation in Patients With Peripheral Artery Disease: Insights From the EUCLID Trial.

Peripheral artery disease (PAD) is associated with increased risk of mortality, cardiovascular morbidity, and major amputation. Data on major amputation from a large randomized trial that included a substantial cohort of patients without critical limb ischemia (CLI) have not been described. The objective was to describe the incidence and types of amputations in the EUCLID trial (Examining Use of Ticagrelor in Peripheral Artery Disease) population, subcategorize amputations in the CLI versus no CLI cohorts, and describe the events surrounding major amputation. Postrandomization major amputation was analyzed in the EUCLID trial. Patients were stratified by baseline CLI status. The occurrence of major amputation was ascertained and defined as the highest level. Perioperative events surrounding major amputation were obtained including acute limb ischemia, revascularization, and all-cause mortality. All variables were assessed for significance in univariable and multivariable models. The rate of major amputation during the course of the trial was 1.6% overall, 8.4% in the CLI at baseline group, and 1.2% in the no CLI at baseline group. The annualized rate of major amputation was 0.6% in PAD overall, 3.9% in the CLI at baseline group, and 0.5% in the no CLI at baseline group. Several factors were associated with increased risk of major amputation, including history of amputation, the presence of diabetes mellitus, baseline Rutherford category 4 to 6, and an ankle-brachial index <0.8. Factors associated with a lower risk for major amputation included prior statin use. The 30-day mortality rate after major amputation was 6.5% overall, 5.6% in the CLI at baseline group, and 6.8% in the no CLI at baseline group. The annual mortality rate following major amputation was 22.8% in the CLI at baseline group and 16.0% in the no CLI at baseline group. The risk factors for major amputation in EUCLID patients are similar to previous large registries' reports except for diabetes mellitus in patients with CLI. The mortality following major amputation is lower in the EUCLID trial compared with registry data. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01732822.

Clinical Outcome Differences Between Single and Multi-stage Transtibial Amputations

Category:Diabetes, Trauma, AmputationIntroduction/Purpose:Transtibial amputations are often necessary when patients experience irreversible tissue damage in their lower extremities. Current amputation methods incorporate either a single-stage amputation with primary wound closure or a two-stage amputation. A two-stage amputation consists of an initial amputation, typically performed at a more distal site, followed by a second more proximal amputation with stump formalization. The reported advantages of two-staged amputations include decreased muscle retraction and the reduced spread of infection/necrosis. This has been reported to allow for reduced failure rates and lower rates of stump revision. Since two-stage amputations are associated with increased monetary costs, time spent in the hospital, and clinical resources used over single-stage amputations, establishing the differences between the clinical outcomes of both types of amputations can provide benefit-cost insight.Methods:This study was a retrospective study, so we began by pulling a query for all patients that underwent a below-the-knee amputation at our institution from January 1, 2015 through January 1, 2018. We excluded revision amputation patients and patients that suffered a traumatic amputation. We will then perform a chart review while recording demographic data, comorbidities, indication for amputation, labs and culture data if present. We will also record the final outcome of the surgery including any revision surgeries. We will collect data on total length of stay and total cost of care from the date of index surgery to the date of prosthetic fitting. For the cost analysis, a Markov model will be used, which can be incorporated with decision tree modeling to estimate the usage of healthcare resources by determining costs through the different phases of healthcare.Results:Our query returned 152 total patients, of which we estimate approximately 25% to 33% underwent a two staged amputation based on the surgeon’s typical amputation preferences. A power analysis was performed which suggested we needed 144 total patients to show a 20% anticipated absolute reduction in complication rates in two-stage amputations compared to single-stage amputations, based on a previous study. We just received the data this week and have not yet performed the full chart review. We hypothesize that two-stage amputations will be considerably more costly than single-stage but that the more involved two-stage strategy may be beneficial in certain subgroups of patients.Conclusion:While we do not yet have the chart review completed for this project, we are excited to elucidate the differences between single-stage and two-stage amputations. We anticipate having all data extracted within the next two months and a complete manuscript by the beginning of the summer. This project has the strong potential to change clinical practice of how trans-tibial amputations are performed depending on the outcome, revision rates, wound complication rates and total healthcare costs.

Risk factors for Diabetic foot amputation in sample of Iraqi patients

Background: Diabetes Mellitus is a metabolic disorder of different etiologies, characterized by chronic hyperglycemia with alterations in metabolism resulting from defects in the secretion or action of insulin. Objective: To assess the risk factors for Diabetic foot amputation. Patients and method: A descriptive cross-sectional study was carried out in the Al-Kindy Teaching hospital, in the period between January 2016 and December2018. The study was constituted by all the elderly patients of 19 years old and more, we studied 120 patients with diabetic foot who collected the inclusion criteria and accepted to participate in the study. Results: Male was more than female and represents 74 (61.7%) patients, while female were represents 46 (38.3%) patients. Amputation treatments were done for 64 diabetic foot patients 50 were male and 14 were female. And 56 patients were treated with non-amputation 24 were male and 32 were female. Highly significant associations were found regarding Age, HbA1c, Dyslipidemia, BMI, HT, and long duration of DM with the amputation treatment. The types of amputation were as follow, Ray's amputation 22(34.37%) patients, and trans-metatarsal amputation in 2 (3.125%) patients, below knee amputation in 16 (25%) patients and above knee in 24 (37.5%) patients. Conclusion: Old age, uncontrolled HbA1c, dyslipidemia, BMI, HT and long duration of DM, is the main risk of Diabetic foot amputation.

Reliability and Validity of Measurement Tools for Residual Limb Volume in People With Limb Amputations: A Systematic Review.

Measurements of residual limb volume often guide decisions on the type and timing of prosthetic prescription. To help inform these decisions, it is important that clinicians use measurement tools that are reliable and valid. The aim of this systematic review was to investigate the reliability and validity of measurement tools for residual limb volume in people with limb amputations. A comprehensive search on MEDLINE, EMBASE, CINAHL, Scopus, and Web of Science was performed on July 11, 2016. Studies were included if they examined the reliability or validity of measurement tools for residual limb volume, were conducted on humans, and were published in English. Data were extracted from 11 reliability and 4 validity studies and included study characteristics, volumetric estimates, and reliability and validity estimates. The quality of the studies was also rated. Data from 2 studies (38 participants) indicated good to excellent intrarater (intraclass correlation coefficient [ICC] ≥0.88) and interrater (ICC ≥0.88) reliability and high between-session reliability (coefficient of variation [CV]= 10%) for water displacement volumetry. One study (28 participants) reported excellent intrarater and interrater reliability (ICC ≥0.93) for the circumferential method, and data from 2 studies (19 participants) indicated high between-session reliability for the optical surface scanner (CV ≤9.8%). Three studies (26 participants) indicated good to excellent between-session reliability results for computed tomography (CV= 9.2%-10.9%). One study (7 participants) showed moderate within-session reliability (CV= 50%). Using water displacement volumetry as the gold standard, 2 studies (79 participants) indicated excellent validity for the circumferential method ( r≥0.92; ICC ≥0.92). All studies reporting measures of reliability or validity were performed with people who had transtibial amputations. Only studies published in English and in which water displacement volumetry was used as the gold standard were included in this review. The reliability and validity of the quality rating scale used in this review have not been tested. On the basis of a limited number of moderate- to high-quality studies with small sample sizes, circumferential and water displacement methods were found to be reliable, and the circumferential method was found to be valid in people with transtibial amputations. There are inadequate data for drawing conclusions about volume measurement methods in people with other types of limb amputations.

Surgical management of eumycetoma: experience from Gezira Mycetoma Center, Sudan

BackgroundIn this study, we share our experience of different operative techniques undertaken on 584 eumycetoma patients in the Gezira Mycetoma Center.MethodsThis is a retrospective, descriptive, hospital-based study, conducted to review the surgical treatment of eumycetoma patients. We included all patients diagnosed with eumycetoma who underwent a surgical operation in the center during January 2013–December 2016.ResultsA total number of 1654 patients were seen during the study period, and their records were revised, while 584 (35.3%) of them underwent an operation and included in the study. There was a male predominance 446 (76.4%). Surgical excision of mycetoma was the commonest operation performed among 513 (87.8%) patients in comparison with amputation 71 (12.2%). Below-knee amputation and toe amputation are the commonest types of amputation in 36 (6.1%) and 14 (2.3%) patients, respectively. Clinical features determining the type of operation performed included the size of the lesion, whether or not a bone was involved, and the feasibility of primary closure. A wide surgical excision (WSE) is performed mainly when the bone is not involved and when moderate or primary closure is possible or reconstruction is feasible. Amputations will typically follow identifying bone involvement, secondary infection, and an already disabled patient.ConclusionThe commonest procedure in our series was WSE and primary skin closure undertaken when the lesion was small (< 5 cm); there was no bone involvement, and the skin closure was achievable. Larger lesions (> 10 cm) without bone involvement were treated with excision and flap/graft. Bone involvement and large primary lesions were more likely to be managed by amputation. Recurrent and relapse of mycetoma were observed in patients with bone involvements or presented with recurrent mycetoma for the second time.

Comparison of diabetic ulcer severity score with types of amputations

Comparison of diabetic ulcer severity score with types of amputations

Diabetic Retinopathy Grade as a Predictive Marker of Stroke and Mortality in Type 2 Diabetes Mellitus Patients with Amputations—Seven-Year Follow-Up

We explored the association of grade of Diabetic Retinopathy (DR) with amputations in 2500, T2DM patients (males 1295, females 1205) who were screened for DR in year 2010, underwent Mini Mental State Examination (MMSE) for cognitive decline, and followed-up for 7 years, till 2017. Cohort was stratified into tertiles based on demographics, grade of DR and type of amputation. DR was observed in 56% patients [Non Proliferative DR (NPDR) n=962, 38%; Proliferative DR (PDR) n=438, 18%] demonstrating a strong association with all types of amputations (p&amp;lt;0.00001), with highest association for amputation of both limbs (n=640) (p&amp;lt;0.00001). Significant association was observed with comorbidities of hypertension, dyslipidemia and hyperhomocysteinemia (p&amp;lt;0.00001). The age tertile of 40-60 years with amputations reported highest number of NPDR and PDR, n=561 and n=263 respectively; highest tertile of HbA1c (&amp;gt;15%) and duration of diabetes (&amp;gt;15 years) corroborated with the high incidence of NPDR (n=421, 70%) and (n=449, 70%), respectively (p&amp;lt;0.00001). MMSE scores revealed a moderate to severe cognitive decline, NPDR (n=453) &amp;gt; PDR (n=231) (p&amp;lt;0.00001). Seven years follow-up revealed high incidence of new amputations (n=610; NPDR n= 372, PDR n=238) (p&amp;lt;0.00001). 637 patients with DR (NPDR, n= 515; PDR n=122) developed stroke (p&amp;lt;0.00001). Two or more fundus lesions increased the propensity of stroke and mortality. The mortality in patients with DR was 33.76% (n=844) of which 282 patients died due to stroke (p&amp;lt;0.00001). Overall, ischemic stroke was the leading cause of mortality in 83.82% patients, with lacunar stroke (n=340) as the commonest anatomical sub-type of stroke (p&amp;lt;0.00001). Patients with DR, especially with NPDR should be managed intensively to prevent fatal cerebrovascular events. Diagnosis of DR in patients who underwent amputations, can be used as a stratified model in association with comorbidities to predict stroke and the mortality. Disclosure K. Shah: None. N. Sundaram: None. A.A. Raut: None. K. Rao: None. N. Wadhwa: None.

Patterns and Causes of Amputation in Ayder Referral Hospital, Mekelle, Ethiopia: A Three-Year Experience.

Amputation is a surgical procedure for the removal of a limb which is indicated when limb recovery is impossible. There are different types of amputation, and their causes can vary from one area to the other. Therefor, the aim of this study is to find out the patterns and causes of amputations in patients presented to Ayder Referral Hospital, Mekelle, Ethiopia. the record of 87 patients who had amputation at different sites after admission to Ayder referral hospital, Mekelle, Ethiopia in three years period were reviewed retrospectively. A total of 87 patients had amputation of which 78.2% were males. The age range was from 3 to 95 years, and the mean age was 40.6 in years. The most common indications were trauma (37.7%), tumor (24.1%), and peripheral arterial disease (PAD) (20.7%). The commonest type of amputation was major lower limb amputation (58.6%) which includes above knee amputation (35.6%)and below knee amputation (23%) followed by digital amputation (17.2%). There was 11.4% major upper limb amputation of which there was one patient who had re-amputation. Most of the indications for amputations in our setup are potentially preventable by increasing awareness in the society on safety measures both at home and at work and early presentation to health facilities.

Prosthetic Reconstruction for a Patient with Partial Hand Amputation

ABSTRACT Introduction Partial hand amputations are one of the most common types of hand amputation. Provision of an aesthetic prosthesis with adequate performance can reduce negative social and psychological impacts of hand amputation. The aim of this study was to describe the fabrication of a silicone prosthesis for a patient with partial hand amputation. Materials and Methods Alginate impression was taken from the residual limb and donor hand. The thumb of the patient on the affected side was covered with a thin layer of silicone so as to not prevent the natural movements of the fingers. A thin layer of wax sculpted on the residual limb plaster mold of the thumb. Four metal wires were put on the residual limb plaster mold. These metal wires are temporary and, after the curing of silicone, are removed from within the final prosthesis to create a suction suspension and lightweight prosthesis. Result In this study, the prosthesis was designed and built for a 30-year-old woman who worked in a toy factory and had four fingers of her left hand amputated. Conclusion The patient was satisfied with the prosthesis in terms of appearance, weight, and color. The thumb function was not limited by the prosthesis. The patient could easily use her thumb while wearing the prosthesis.

Emergency Department Wait Time and Treatment of Traumatic Digit Amputation: Do Race and Insurance Matter?

Little is known about the association between the quality of trauma care and management of nonfatal injuries. The authors used emergency department wait times as a proxy for hospital structure, process, and availability of on-call surgeons with microsurgical skills. They evaluated the association between average hospital emergency department wait times and likelihood of undergoing digit replantation for patients with traumatic amputation digit injuries. The authors hypothesized that hospitals with shorter emergency department wait times were associated with higher odds of replantation. Using the 2007 to 2012 National Trauma Data Bank, the authors' final sample included 12,126 patients. Regression modeling was used to first determine factors that were associated with longer emergency department wait times among patients with digit amputation injuries. Second, the authors examined the association between emergency department wait times for this population at a hospital level and replantation after all types of digit amputation and after complicated thumb amputation injuries only. For patients with simple and complicated thumb amputation injuries, and patients with complicated thumb amputation injuries only, longer emergency department wait times were associated with lower odds of replantation. In addition, being minority and having no insurance were associated with longer emergency department wait times; teaching hospitals were associated with shorter emergency department wait times; and finally, for patients with complicated thumb amputation injuries only, there was no association between patients' minority or insurance status and replantation. Variation in emergency department wait time and its effects on treatment of traumatic digit amputation may reflect maldistribution of hand or plastic surgeons with the required microsurgical skills among trauma centers across the United States. Therapeutic, III.

Design and Evaluation of a Passive Ankle Prosthesis With Powered Push-Off

Below-knee amputation is one of the most frequently performed types of amputation in the United States. This paper describes CamWalk, a novel passive ankle prosthesis that has mechanical behavior similar to that of a natural ankle. CamWalk generates rotational push-off to propel the walker forward using a compliant coupling between two degrees-of-freedom (DOFs) (deflection along the leg and rotation about the ankle). The design closely matches the ankle torque and ankle work characteristics of an average healthy ankle. Simulation results indicate that CamWalk generates 44.5% of the net rotational work performed by a natural healthy ankle when leg deflection is limited to 15 mm. Standard gait analysis of four amputees using CamWalk demonstrated that the device performance ranged from marginally dissipative to significantly active, generating 48.0% of the work performed by their natural ankle.