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Transtibial Amputees from the Vietnam War

Twenty-eight-Year Follow-up

Investigation performed at the University of Louisville, Louisville, Kentucky
LTC Paul J. Dougherty, United States Army Medical Corps William Beaumont Army Medical Center, 5005 North Piedras, El Paso, TX 79920. E-mail address: paul.dougherty{at}amedd.army.mil
The views expressed herein are those of the author and do not reflect the official policy or position of the Department of the Army, the Department of Defense, or the United States Government.
Although none of the authors has received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article, benefits have been or will be received, but are directed solely to a research fund, foundation, educational institution, or other nonprofit organization with which one or more of the authors is associated. Funds were received in total or partial support of the research or clinical study presented in this article. The funding source was the United States Army Medical Research and Material Command, Fort Detrick, Maryland. Funding number DAMD 17-97-1-7148.

Background: The long-term functional outcome following lower-extremity amputation is not well documented. I ascertained the functional outcome and health status of patients who had sustained a unilateral transtibial amputation as a result of a battlefield injury.

Methods: The records of 123 patients who had been treated at Valley Forge Army General Hospital during the Vietnam War for a diagnosis of isolated transtibial amputation due to a battlefield injury were reviewed. Group 1 had an isolated transtibial amputation, and Group 2 had at least one other major injury (another major long-bone fracture of the lower extremity, burns covering >20% of the body surface area, or a chest, abdominal, face, or head wound) in addition to the transtibial amputation. Seventy-two (59%) of the patients were enrolled in the study: twenty-eight were in Group 1 and forty-four, in Group 2. Data were collected about employment status, marital status, whether the patient had children, and use of psychological support services. The Short Form-36 (SF-36) health survey was used to compare Group 1 and Group 2, individually and combined, with age and gender-matched controls. Scaled scores for the two groups (control and amputation) were compared with use of the Student t test (two-tailed).

Results: Tripping a land mine or booby trap caused 65% of the injuries. The average age at the time of follow-up was forty-eight years. The average time to follow-up was twenty-eight years. Only the prevalence of the use of psychological support services differed significantly between Groups 1 and 2 (21% compared with 50%; p = 0.015). The results of the SF-36 health survey for Groups 1 and 2 were 81.6 and 58.2, respectively, for physical function, 82.7 and 33.1 for role physical, 81.4 and 50.9 for bodily pain, 74.1 and 58.7 for general health, 67.1 and 51.5 for vitality, 89.1 and 70.4 for social function, 88.1 and 56.0 for role emotional, and 79.5 and 64.0 for mental health. The average scaled scores for Group 1 were similar to those for the age and gender-matched controls, but the scores for Group 2 were significantly lower (p £ 0.001) than those for the age and gender-matched controls in all categories.

Conclusions: Group-1 patients led relatively normal lives after sustaining a transtibial amputation in battle. The addition of another major injury (Group 2) appears to have significant long-term consequences with regard to SF-36 scores and the need for psychological care.

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