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CME 2: April, May, June 2004
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The Journal of Bone and Joint Surgery (American) 86:923-928 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Demographics of Traumatic Amputations in Children

Implications for Prevention Strategies

Randall T. Loder, MD1

1 Riley Hospital for Children, 702 Barnhill Drive, Room 4250, Indianapolis, IN 46202. E-mail address: rloder{at}iupui.edu

Investigation performed at Shriners Hospital for Children/Twin Cities, Minneapolis, Minnesota

The author did not receive grants or outside funding in support of his research or preparation of this manuscript. He did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the author is affiliated or associated.

Background: The demographics of traumatic amputations in children are not well known. The purpose of this review was to identify those demographics for use as a possible guide for prevention strategies.

Methods: The study was a retrospective review of the data on children with traumatic amputation who had received care at one center in the upper midwestern United States from 1980 to 2000. The child's gender and age at the time of the amputation, the date and etiology of the amputation, and the amputation level were tabulated. Statistical analyses of seasonal variations were performed.

Results: There were 256 amputations in 235 children. The mean age (and standard deviation) at the time of the amputation was 7.9 ± 5.0 years. The amputation involved one extremity in 217 children, two extremities in sixteen, and three and four extremities in one child each. Of the 256 amputations, 165 involved the lower extremity. The traumatic amputation was caused by a lawnmower in sixty-nine children, farm machinery in fifty-seven, a motor-vehicle accident in thirty-eight, a train in twenty, and miscellaneous mechanisms in fifty-one. The mean age at the time of the injury varied according to the mechanism of injury and ranged from 1.9 years for burns to 11.5 years for boating injuries. Fifty-four (78%) of the sixty-nine children with a lawnmower amputation were five years of age or less. There were significant seasonal variations: the mean date of the lawnmower injuries was June 10, the mean date of the farming injuries was September 2, and the mean date of the motor-vehicle-related injuries was July 16.

Conclusions: There are common patterns of traumatic amputations in children based on the mechanism of injury, the season, and the age of the child. The ideal time for an educational campaign for the prevention of lawnmower injuries appears to be March and April and should be directed toward parents. The best times for such a campaign for the prevention of farming-related accidents appear to be both the spring and the early fall, and the campaign should be directed toward both parents and older children.

Level of Evidence: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.


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