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Pattern of upper limb amputation associated with lower limb amputation: the UK military experience from Iraq and Afghanistan
  1. Louise McMenemy1,2,
  2. V Mondini3,
  3. D C Roberts4,
  4. A Kedgley3,
  5. J C Clasper2 and
  6. S A Stapley1,4
  1. 1Academic Department for Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
  2. 2Centre for Blast Injury Studies, Imperial College London, London, UK
  3. 3Bioengineering, Centre for Blast Injury Studies, Imperial College London, London, UK
  4. 4Department of Trauma & Orthopaedics, Queen Alexandra Hospital, Portsmouth, UK
  1. Correspondence to Surg Lt Cdr Louise McMenemy, Academic Department for Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK; louisemcmenemy{at}doctors.org.uk

Abstract

Introduction The conflicts in Iraq and Afghanistan resulted in large numbers of personnel sustaining extremity injuries. In the context of polytrauma, partial hand amputation is often unrecorded. The aim of this work was to quantify the burden of upper limb (UL) amputation at any level occurring concurrently with a major (ankle and proximal) lower limb (LL) amputation. Knowledge of this cohort could aid in prosthetic modification to further improve quality of life outcomes in a population with dexterity loss.

Method A trauma database search was undertaken for all UK military LL amputees from the conflicts in Iraq and Afghanistan. A manual search method was employed to identify from the major LL amputees those who had a concurrent UL amputation at any level (including isolated finger amputation). Demographics, level of amputation, and injury profile data were recorded.

Results Sixty-eight individuals were identified; the most prevalent population was bilateral LL with a unilateral UL amputation (60%). Most UL amputations were partial hand (75%). The was no statistically significant difference between left or right side (p=0.13). On the left side, correlation was found between amputation of the thumb and third digit (rho=0.34; p=0.005) not seen on the right.

Conclusion We have determined the rate of UL amputation at any level, in combination with LL amputation as a result of blast injury. Knowledge of these combinations enables further research to support anecdotal evidence that there is a need for tailored prosthetics in the context of potential dexterity loss making donning and doffing problematic.

  • trauma management
  • hand & wrist
  • limb reconstruction
  • trauma management

Data availability statement

No data are available. Data may be available to parties with sufficient military security clearance but will not be made routinely available.

Statistics from Altmetric.com

Data availability statement

No data are available. Data may be available to parties with sufficient military security clearance but will not be made routinely available.

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Footnotes

  • Twitter @loumcmenemy

  • Contributors All authors confirm they have contributed substantially and materially to this work in the following ways: LM—planned the study, collected data, pulled the analysed results together, wrote the first draft and made amendments to produce the final manuscript. VM—analysed data, provided the figures presenting the results and amended drafts. DCR—aided in study planning, provided input into interpretation of results and amended drafts. AK—aided in interpretation of results and amended drafts. JC—conceived the idea, planned the study, aided in interpretation of results and amended drafts. SAS—conceived the idea, planned the study, aided in interpretation of results and amended drafts.

  • Funding This work was supported by the Centre for Blast Injury Studies, Imperial College London, which is part funded by the Royal British Legion.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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