The incidence of multiple traumatic limb loss is rising among service
members in battle, also increasing the mortality rate, the rehabilitation time
and the difficulty of prosthetic fitting.
Despite these severe injuries, however, veterans from the Vietnam War
report relatively normal function nearly 40 years after injury, according to a
study presented at the Annual Meeting of the American Academy of Orthopaedic
Paul J. Dougherty, MD, associate professor and the orthopedic surgery
residency program director at University of Michigan in Ann Arbor, compared the
multiple traumatic limb loss of veterans from the Vietnam War and those from
the Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) conflict,
including the health status, prosthetic use and prognosis for each patient.
Dougherty, lead author on the study, surveyed a total of 501 Vietnam
amputees, and 541 OIF/OEF amputees from 2007 to 2008. The survey looked at
levels of amputations, other injuries, employment, marriage and children,
self-reported health status, self-reported quality of life, comorbidities,
current functional capability for upper and lower extremities, and types of
prostheses ever used or currently used, he said during his presentation.
Approximately 24.5% of the Vietnam amputees, and 21.5% of the OIF/OEF
amputees, reported multiple limb loss. Overall, researchers found 44 different
combinations of levels of amputation accounting for the multiple limb loss,
with bilateral lower limb loss being the most common combination — about
70% in both groups, Dougherty said. The majority of veterans reported lower
limb amputations, with bilateral transfemoral, transfemoral/transtibial and
bilateral transtibial as the most common levels reported.
The study also found self-reported health was
“good-to-excellent” with almost 40% of the Vietnam respondents, and
with almost 60% of the OIF/OEF respondents.
Despite their disability, 76% of the Vietnam veterans reported being
currently employed. Of the same group, 76% reported being currently married and
19% reported being divorced.
“This is actually better than other published U.S. studies across
the board,” Dougherty said.
Of the same group, 85% said they had children.
The veterans reported a variety of comorbidities, including back pain,
arthritis, phantom limb pain and residual limb pain, migraine headaches,
traumatic brain injury, depression and post-traumatic stress disorder (PTSD).
“The arthritis, as expected, was significantly higher with the
Vietnam group,” Dougherty said.
The OIF/OEF amputees reported a significantly greater percentage of
migraines and traumatic brain injury compared to those in Vietnam group.
Dougherty also found that the OIF/OEF amputees had a greater number of
surgeries on the residual limb following amputation.
In the category of lower extremity functional ability, researchers
evaluated amputees in seven categories, ranging from non-ambulators to
low-impact and high-impact activities. The Vietnam amputees reported lower
levels of activity and the OIF/OEF amputees reported higher levels of activity.
“If we [look at] the two non-ambulatory categories, fully one-third
of those from the Vietnam conflict reported being non-ambulatory, and that was
significantly different from the OIF/OEF group,” Dougherty said.
“Whereas, [in] the low- and high-impact [categories], about 40% from the
OIF/OEF group reported being able to do those types of activities, and that was
also significantly different.”
Among the upper extremity amputees, there was no significant difference
between the two groups in completing activities of daily living with a
prosthesis, with one hand or with the help of someone else. Total prosthetic
use per year was higher among the OIF/OEF amputees — 5.4% — than
among Vietnam amputees — 1.8%; and only 5% of OIF/OEF amputees reported
abandoning those prostheses, which is significantly less than the Vietnam
amputees, who reported 30% abandonment.
Dougherty said that additional pain management research is necessary
because of the significant numbers of amputees reporting phantom limb pain,
back pain and residual limb pain, as well as better support for PTSD and
depression because of its high prevalence in both the Vietnam and OIF/OEF
groups. He also called for prosthetics research to improve prosthetic devices
and veterans’ ability to ambulate. — by Stephanie Z. Pavlou
For more information:
- Dougherty PJ. Multiple limb loss due to battle injuries. Paper
#643. Presented at the 2010 Annual Meeting of the American Academy of
Orthopaedic Surgeons. March 9-13, 2010. New Orleans.
If there were ever an overlooked group of modern amputees, it would be
those from the Vietnam War. Although official government statistics do not
appear to exist, it is a considered inference that during 1968-1969 the number
American casualties with a major limb amputation would exceed the current
aggregate total of Operation Iraqi Freedom and Operation Enduring Freedom. I
applaud any effort to study this valuable resource and wish to add that Dr.
Dougherty has written several excellent manuscripts on the long-term follow up
of Vietnam amputees (PMID: 10535588, PMID: 11263642, PMID: 12707534).
— Charles King, CP
Control Inc. and partner, O&P Virtual Library, Digital Resource Foundation
for the Orthotics & Prosthetics Community