Advances in Amputee Care

Pasquina, Paul F.; Bryant, Phillip R.; Huang, Mark E.; Roberts, Toni L.; Nelson, Virginia S.; Flood, Katherine M.

doi:10.1016/j.apmr.2005.11.026

Cited by 78 publications

(39 citation statements)

References 56 publications

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“…After adjusting for ISS and amputation location, servicemembers with a recorded TBI, on average, required a significantly greater number of physical therapy, occupational therapy, and combined medical and rehabilitative visits over the 2 yr follow-up period. For outpatient visits, we observed a relatively high use of outpatient physical therapy, occupational therapy, and prosthetic training services soon after the injury, which is similar to those reported by others [21,34,[42][43]. Throughout much of the 2 yr follow-up period, the mean number of occupational therapy visits remained higher for servicemembers with TBI relative to those without TBI.…”

Section: Medical and Rehabilitative Visits By Traumatic Brain Injury supporting

confidence: 76%

Effect of traumatic brain injury among U.S. servicemembers with amputation

Rauh¹,

Aralis²,

Melcer³

et al. 2013

JRRD

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Abstract-Servicemembers with combat-related limb loss often require substantial rehabilitative care. The prevalence of traumatic brain injury (TBI), which may impair cognitive and functional abilities, among servicemembers has increased. The primary objectives of this study were to determine the frequency of TBI among servicemembers with traumatic amputation and examine whether TBI status was associated with discharge to civilian status and medical and rehabilitative service use postamputation. U.S. servicemembers who had a combat-related amputation while deployed in Iraq or Afghanistan between 2001 and 2006 were followed for 2 yr postamputation. Data collected includes injury mechanism; postinjury complications; Injury Severity Score (ISS); and follow-up data, including military service discharge status and number of medical, physical, occupational therapy, and prosthetic-related visits. Of the 546 servicemembers with combat-related amputations, 127 (23.3%) had a TBI diagnosis. After adjusting for ISS and amputation location, those with TBI had a significantly greater mean number of medical and rehabilitative outpatient and inpatient visits combined (p < 0.01). Those with TBI were also at greater odds of developing certain postinjury complications. We recommend that providers treating servicemembers with limb loss should assess for TBI because those who sustained TBI required increased medical and rehabilitative care.

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Section: Medical and Rehabilitative Visits By Traumatic Brain Injury supporting

confidence: 76%

Effect of traumatic brain injury among U.S. servicemembers with amputation

Rauh¹,

Aralis²,

Melcer³

et al. 2013

JRRD

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“…Recent combat amputees are relatively young, fit, and motivated to pursue higher-level activities using prosthetics, such as running and sports [5,9]. Nonetheless, the surgical and rehabilitation teams for this case series emphasized nonsurgical management consisting of multiple attempts to minimize symptoms through prosthetic adjustments and/ or pain management techniques.…”

Section: Discussionmentioning

confidence: 99%

“…Briefly, nonsteroidal anti-inflammatory agents (e.g., Celebrex) can inhibit excess bone growth and therefore are contraindicated for patients with fractures because these medications can inhibit the healing of long bone fractures. Afghanistan and Iraq war combat amputees often sustain substantial injuries other than amputation including fractures and soft-tissue damage [5,9]. Celebrex in particular is not known to interfere with blood platelets or clotting to increase bleeding like other nonsteroidal antiinflammatory agents.…”

Section: Discussionmentioning

confidence: 99%

“…They were selected to illustrate the range of HO care issues encountered by the physician in recent years in military amputee clinics [5,9], particularly those relevant for optimizing prosthetic use by lower-limb amputees. These issues included symptoms and location of excess bone growth relative to the prosthetic, prosthetic modifications, preventive medications, HO after delayed or elective amputation, possible benefits of HO for prosthetic fitting, and risks and/or benefits of surgical excision.…”

Section: Symptoms Radiographs and Case Historiesmentioning

confidence: 99%

“…These descriptions are important, given the unique injury profiles of recent combat amputees [9][10][11][12] and the high frequency of HO occurring in this population [1,2,13]. Patient histories can be instructive for both civilian and military prosthetists, surgeons, and physical rehabilitation specialists.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Heterotopic ossification in combat amputees from Afghanistan and Iraq wars: Five case histories and results from a small series of patients

Melcer

Belnap²,

Walker³

et al. 2011

JRRD

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Abstract-Heterotopic ossification (HO) is excess bone growth in soft tissues that frequently occurs in the residual limbs of combat amputees injured in Operation Iraqi Freedom and Operation Enduring Freedom, or Iraq and Afghanistan wars, respectively. HO can interfere with prosthetic use and walking and delay patient rehabilitation. This article describes symptomatic and/or radiographic evidence of HO in a patient series of combat amputees rehabilitating at a military amputee care clinic (27 patients/33 limbs). We conducted a retrospective review of patient records and physician interviews to document evidence of HO symptoms in these limbs (e.g., pain during prosthetic use, skin breakdown). Results showed HO-related symptoms in 10 of the 33 residual limbs. Radiographs were available for 25 of the 33 limbs, and a physician identified at least moderate HO in 15 of the radiographs. However, 5 of the 15 patients who showed at least moderate radiographic HO did not report adverse symptoms. Five individual patient histories described HO onset, symptoms, treatments, and outcomes. These case histories illustrated how HO location relative to pressure-sensitive/pressuretolerant areas of the residual limb may determine whether patients experienced symptoms. These histories revealed the uncommon but novel finding of potential benefits of HO for prosthetic suspension.

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Amputation

Fahie

2016

Complications in Small Animal Surgery

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Advances in Amputee Care

Cited by 78 publications

References 56 publications

Effect of traumatic brain injury among U.S. servicemembers with amputation

Effect of traumatic brain injury among U.S. servicemembers with amputation

Heterotopic ossification in combat amputees from Afghanistan and Iraq wars: Five case histories and results from a small series of patients

Amputation

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