This Article Full Text Full Text (PDF) CME: Take the activities for this article: Trauma Test 4: Topics in Trauma Surgery CME 3: July, August, September 2004 [Supplementary Material] An erratum has been published Letters to the Editor: Submit a response Letters to the Editor: View responses Alert me when this article is cited Alert me when Letters to the Editor are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Reprints and Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by MacKenzie, E. J. Articles by McCarthy, M. L. Search for Related Content PubMed PubMed Citation Articles by MacKenzie, E. J. Articles by McCarthy, M. L. Social Bookmarking             What's this?

Functional Outcomes Following Trauma-Related Lower-Extremity Amputation

¹ Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 554, Baltimore, MD 21205. E-mail address for E.J. MacKenzie: emackenz{at}jhsph.edu
² Department of Orthopaedic Surgery, Carolinas Medical Center, 1000 Blythe Boulevard, Suite 306, Charlotte, NC 28232-2861
³ Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 545, Baltimore, MD 21205
⁴ Department of Orthopaedics, Harborview Medical Center, 325 Ninth Avenue, ZA-48, Seattle, WA 98104
⁵ Wake Forest University, Bowman Gray School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1070
⁶ Orthopedics Associates of Portland, 33 Sewall Street, P.O. Box 1260, Portland, ME 04104
⁷ Department of Orthopaedic Surgery, University of Minnesota, 420 Delaware Street S.E., Box 492 Mayo, Minneapolis, MN 55455
⁸ Florida Orthopedic Institute, 4175 East Fowler Avenue, Tampa, FL 33617-2011
⁹ University of Maryland at Baltimore, R Adams Cowley Shock Trauma Center, 22 South Greene Street, Baltimore, MD 21201
¹⁰ Vanderbilt University Hospital, 1161 21st Avenue South, Medical Center North, T-4311, Nashville, TN 37232-2550
¹¹ Department of Orthopaedics, MetroHealth Medical Center, 2500 Metro-Health Drive, Cleveland, OH 44109-1998
¹² Wyeth Research, 87 Cambridgepark Drive, MS 3100-60, Madison, NJ 02140
¹³ Department of Emergency Medicine, Johns Hopkins School of Medicine, 1830 East Monument Street, Suite 6-100, Baltimore, MD 21205

In support of their research or preparation of this manuscript, one or more of the authors received Grant ROI-AR42659 from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. Commercial entities (Zimmer and Synthes USA) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which one or more of the authors are affiliated or associated.

Methods: A cohort of 161 patients who had undergone an above-the-ankle amputation at a trauma center within three months following the injury was followed prospectively at three, six, twelve, and twenty-four months after the injury. The Sickness Impact Profile, a self-reported measure of functional status, was used as the principal measure of outcome. Secondary outcomes included pain; degree of independence in transfers, walking, and climbing stairs; self-selected walking speed; and the physician's satisfaction with the clinical, functional, and cosmetic recovery of the limb. Longitudinal multivariate regression techniques were used to determine whether outcomes differed according to the level of amputation after we controlled for covariates.

Results: There was no significant difference in the scores on the Sickness Impact Profile between the patients treated with above-the-knee and those treated with below-the-knee amputation. However, patients with a below-the-knee amputation performed better than did patients with an above-the-knee amputation on the timed test for walking speed (p = 0.04). Patients with a through-the-knee amputation had worse regression-adjusted Sickness Impact Profile scores (p = 0.05) and slower self-selected walking speeds (p = 0.004) than did patients with either a below-the-knee or an above-the-knee amputation. Differences according to the level of amputation were most pronounced for physical function. In general, physicians were less satisfied with the clinical, cosmetic, and functional recovery of the patients with a through-the-knee amputation. Except for problems encountered with insufficient gastrocnemius coverage of the stump in many patients with a through-the-knee amputation, neither the soft-tissue coverage nor the technological sophistication of the prosthesis correlated with outcome.

Conclusions: Severe disability accompanies above-the-ankle lower-extremity amputation following trauma, regardless of the level of amputation. Clinicians should critically evaluate the need for a through-the-knee amputation in patients with a traumatic injury. The results of this study also underscore the need for controlled studies that examine the relationship between the type and fit of prosthetic devices and functional outcomes.

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

CiteULike    Connotea    Del.icio.us    Technorati    What's this?

This article has been cited by other articles:

				M. G. Stineman, J. E. Kurichi, P. L. Kwong, G. Maislin, D. M. Reker, W. B. Vogel, J. A. Prvu-Bettger, D. E. Bidelspach, and B. E. Bates Survival Analysis in Amputees Based on Physical Independence Grade Achievement Arch Surg, June 1, 2009; 144(6): 543 - 551. [Abstract] [Full Text] [PDF]

				P. E. Levin and E. J. Levin The Experience of an Orthopaedic Traumatologist When the Trauma Hits Home: Observations and Suggestions J. Bone Joint Surg. Am., September 1, 2008; 90(9): 2026 - 2036. [Full Text] [PDF]

				A. I Greenspan, S. L Wolf, M. E Kelley, and M. O'Grady Tai Chi and Perceived Health Status in Older Adults Who Are Transitionally Frail: A Randomized Controlled Trial Physical Therapy, May 1, 2007; 87(5): 525 - 535. [Abstract] [Full Text] [PDF]

				J M van Velzen, C A. van Bennekom, W Polomski, J R Slootman, L H. van der Woude, and H Houdijk Physical capacity and walking ability after lower limb amputation: a systematic review Clinical Rehabilitation, November 1, 2006; 20(11): 999 - 1016. [Abstract] [PDF]

				E. J. MacKenzie and M. J. Bosse Factors Influencing Outcome Following Limb-Threatening Lower Limb Trauma: Lessons Learned From the Lower Extremity Assessment Project (LEAP) J. Am. Acad. Ortho. Surg., September 1, 2006; 14(10): S205 - S210. [Abstract] [Full Text] [PDF]

				C. S. Roberts, H.-C. Pape, A. L. Jones, A. L. Malkani, J. L. Rodriguez, and P. V. Giannoudis Damage Control Orthopaedics. Evolving Concepts in the Treatment of Patients Who Have Sustained Orthopaedic Trauma J. Bone Joint Surg. Am., February 1, 2005; 87(2): 434 - 449. [Full Text] [PDF]

				N. Hebela, D. G. Smith, and M. A. Keenan What's New in Orthopaedic Rehabilitation J. Bone Joint Surg. Am., November 1, 2004; 86(11): 2577 - 2581. [Full Text] [PDF]

Letters to the Editor:

Stanford University Libraries' HighWire Press (TM) assists in the publication of JBJS Online.
Copyright © 2004 by The Journal of Bone and Joint Surgery, Inc. Online ISSN: 1535-1386.
The Journal of Bone and Joint Surgery®, JBJS®, JB&JS®, and eJBJS® are registered in the U.S. Patent and Trademark Office.