Upper Extremity Amputations Require Additional Physical, Psychological Care

Compared with military service members with lower extremity amputations, upper extremity amputees have different characteristics and debilitating features that make them far less likely to return to duty, according to a study published in Injury.

These differences are important for O&P practitioners to consider in the treatment of this patient population, as they may require additional resources beyond standard amputee care.

“This study on upper extremity amputees was conducted in order to explore the characterizations of our combat related upper extremity amputees and their associated sources of disability,” David J. Tennent, of the Department of Orthopaedics and Rehabilitation at the San Antonio Military Medical Center, told O&P Business News. “Over the past decade, there has been a lot of focus on lower extremity amputees and their rehabilitation; however, there has not been as much information available regarding the isolated upper extremity amputees. We wanted to better investigate our upper extremity population with the hopes of providing better care for them in the future.”

Differences in upper, lower amputations

Researchers conducted a retrospective study of all major extremity amputations sustained by 1,221 U.S. military service members from October 2001 to July 2011. Researchers obtained injury characteristics, demographic information, treatment characteristics and disability outcome data from the Department of Defense Trauma Registry, the Armed Forces Health Longitudinal Technology Application and the Physical Evaluation Board Liaison Offices.

Overall, they identified 173 service members who had an isolated upper extremity amputation. According to study results, isolated upper extremity and isolated lower extremity amputees had similar injury severity scores. Researchers also found isolated upper extremity amputees had a significantly greater combined disability rating and were more likely to receive a disability rating of greater than 80%. No upper extremity amputees were found fit for duty, and 12 service members were allowed to continue on active duty. Compared with lower extremity amputees, significantly more upper extremity amputees were permanently retired.

Study results showed upper extremity amputees were significantly more likely to have disability from post-traumatic stress disorder (PTSD) and loss of nerve function compared with the general amputee population, “Our upper extremity population is a unique population due to the nature of their injuries as well as their rehabilitation options,” Tennent said. “We are fortunate to have top-tier rehabilitation centers, such as the Center for the Intrepid at Ft. Sam Houston, Texas, whose focus is to optimize the outcomes of our injured soldiers. We hope that this study allows us to continue to improve our care for our injured soldiers by identifying areas of continued need.”

Hindrance to recovery

Tennent found the higher rates of retirement from military service and PTSD-related disability in upper extremity amputees to be notable.

“This may reflect the continued difficulties the upper extremity amputees have as they proceed through rehabilitation and prosthetic use or may represent a different type of injury pattern sustained by upper extremity amputees compared to lower extremity amputees,” he said. “For example, injuries occur closer to the head, leading to more psychological conditions that may impede rehab and recovery.”

Tennent said more investigation into the functional outcomes of the upper extremity amputee population is needed to determine how to better treat them.

“Our hope is that this study brings attention to the unique needs of our upper extremity amputees,” Tennent said. “Following these patients longitudinally into the future to determine the long-term disabilities stemming from their injuries and treatment would be helpful from a clinical standpoint, too.” — by Casey Tingle

For more information:
Tennent DJ. Injury. 2014;45:965-969.

Disclosure: Tennent has no relevant financial disclosures.

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