Characteristics and outcomes of hip fractures in lower limb amputees

Haleem, Shahnawaz; Yousaf, Sohail; Hamid, Tengku Aizan; Nagappa, Satish; Parker, Martyn J.

doi:10.1016/j.injury.2020.10.017

Cited by 11 publications

(7 citation statements)

References 15 publications

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“…(31) Although outcomes for amputees sustaining hip fractures have not been shown to be different from an age-matched population, the only studies in the literature looking at outcomes are for patients over the age of 50 years. (32) The traumatic amputee population seen in both the UK and allied nations following recent conflicts are much younger than the traditional diabetic or vascular amputee and the results here show that they are highly active. Therefore, at a much younger age there is a potential increased risk of femoral neck fracture in the presence of BMD loss resulting in reduced activity levels, prosthetic fit difficulties, and generalized deconditioning.…”

Section: Discussionmentioning

confidence: 64%

Association Between Combat‐Related Traumatic Injury and Skeletal Health: Bone Mineral Density Loss Is Localized and Correlates With Altered Loading in Amputees: the Armed Services Trauma Rehabilitation Outcome (ADVANCE) Study

McMenemy

Behan

Kaufmann

et al. 2023

J of Bone & Mineral Res

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The association between combat‐related traumatic injury (CRTI) and bone health is uncertain. A disproportionate number of lower limb amputees from the Iraq and Afghanistan conflicts are diagnosed with osteopenia/osteoporosis, increasing lifetime risk of fragility fracture and challenging traditional osteoporosis treatment paradigms. The aim of this study is to test the hypotheses that CRTI results in a systemic reduction in bone mineral density (BMD) and that active traumatic lower limb amputees have localized BMD reduction, which is more prominent with higher level amputations. This is a cross‐sectional analysis of the first phase of a cohort study comprising 575 male adult UK military personnel with CRTI (UK‐Afghanistan War 2003 to 2014; including 153 lower limb amputees) who were frequency‐matched to 562 uninjured men by age, service, rank, regiment, deployment period, and role‐in‐theatre. BMD was assessed using dual‐energy X‐ray absorptiometry (DXA) scanning of the hips and lumbar spine. Femoral neck BMD was lower in the CRTI than the uninjured group (T‐score −0.08 versus −0.42 p = .000). Subgroup analysis revealed this reduction was significant only at the femoral neck of the amputated limb of amputees (p = 0.000), where the reduction was greater for above knee amputees than below knee amputees (p < 0.001). There were no differences in spine BMD or activity levels between amputees and controls. Changes in bone health in CRTI appear to be mechanically driven rather than systemic and are only evident in those with lower limb amputation. This may arise from altered joint and muscle loading creating a reduced mechanical stimulus to the femur resulting in localized unloading osteopenia. This suggests that interventions to stimulate bone may provide an effective management strategy. © 2023 Crown copyright and The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR). This article is published with the permission of the Controller of HMSO and the King's Printer for Scotland.

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Section: Discussionmentioning

confidence: 64%

Association Between Combat‐Related Traumatic Injury and Skeletal Health: Bone Mineral Density Loss Is Localized and Correlates With Altered Loading in Amputees: the Armed Services Trauma Rehabilitation Outcome (ADVANCE) Study

McMenemy

Behan

Kaufmann

et al. 2023

J of Bone & Mineral Res

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“…A recent review demonstrated that over-reliance on the intact leg in people with unilateral lower limb loss significantly decreased bone density and increased muscle atrophy in the residual limb ( Finco et al, 2022 ). The loss of muscle strength, in addition to balance instability, leads to a higher rate of falls ( Steinberg et al, 2018 ), and the loss of bone increases the likelihood of fall-related fractures ( Haleem et al, 2021 ). Further, reliance on the intact leg leads to overuse injuries such as osteoarthritis ( Lloyd et al, 2010 ), chronic low back pain ( Kulkarni et al, 2005 ), and lumbar spine injuries ( Farrokhi et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

The experience of sensorimotor integration of a lower limb sensory neuroprosthesis: A qualitative case study

Schmitt

Wright

Triolo

et al. 2023

Front. Hum. Neurosci.

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IntroductionLower limb prosthesis users often struggle to navigate uneven terrain or ambulate in low light conditions where it can be challenging to rely on visual cues for balance and walking. Sensory feedback about foot-floor interactions may allow users to reduce reliance on secondary sensory cues and improve confidence and speed when navigating difficult terrain. Our group has developed a Sensory Neuroprosthesis (SNP) to restore sensation to people with lower limb amputation by pairing electrical stimulation of nerves in the residual limb applied via implanted neurotechnology with pressure sensors in the insole of a standard prosthesis. Stimulation applied to the nerves evoked sensations perceived as originating on the missing leg and foot.MethodsThis qualitative case study reports on the experiences of a 68-year-old with a unilateral trans-tibial amputation who autonomously used the SNP at home for 31 weeks. Interview data collected throughout the study period was analyzed using a grounded theory approach with constant comparative methods to understand his experience with this novel technology and its impacts on his daily life.ResultsA conceptual model was developed that explained the experience of integrating SNP-provided sensory feedback into his body and motor plans. The model described the requirements of integration, which were a combination of a low level of mental focus and low stimulation levels. While higher levels of stimulation and focus could result in distinct sensory percepts and various phantom limb experiences, optimal integration was associated with SNP-evoked sensation that was not readily perceivable. Successful sensorimotor integration of the SNP resulted in improvements to locomotion, a return to a more normal state, an enhancement of perceived prosthesis utility, and a positive outlook on the experience.DiscussionThese outcomes emerged over the course of the nearly 8 month study, suggesting that findings from long-term home studies of SNPs may differ from those of short-term in-laboratory tests. Our findings on the experience of sensorimotor integration of the SNP have implications for the optimal training of SNP users and the future deployment of clinical SNP systems for long-term home use.

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“…Moreover, scientific data showed that in people with LLA, bone demineralization mainly occurs in the hip of the impaired lower limb (Leclercq et al, 2003;Sherk et al, 2008;Smith et al, 2011Smith et al, , 2009Bemben et al, 2017), especially in those with an above-knee amputation (AKA). For these reasons, regardless of age and other risk factors, people with lower limb amputation (LLA) suffer from bone demineralization and, consequently, they are at risk of osteoporosis and fragility fractures (Leclercq et al, 2003;Sherk et al, 2008;Cavedon et al, 2021;Haleem et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Sporting activity does not fully prevent bone demineralization at the impaired hip in athletes with amputation

Cavedon

Sandri²,

Peluso³

et al. 2022

Front. Physiol.

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There is lack of information about bone mineralization at the lumbar spine and bilateral hips of athletes with unilateral lower limb amputation. The present study assessed for the first time the areal bone mineral density at the lumbar spine and at the hip of the able and impaired leg by means of Dual-Energy X-Ray Absorptiometry using a large sample (N = 40) of male athletes. Results showed that bone demineralization in athletes with unilateral lower limb amputation is found at the impaired hip but not at the lumbar spine and may therefore be site-specific. The extent of hip demineralization was influenced by the level of amputation, with about 80% of athletes with above knee amputation and 10% of athletes with below knee amputation showing areal bone mineral density below the expected range for age. Nevertheless, a reduced percentage of fat mass and a lower fat-to-lean mass ratio in the residual impaired leg as well as a greater amount of weekly training was positively associated with bone mineralization at the impaired hip (partial correlation coefficients = 0.377–0.525, p = 0.040–0.003). Results showed that participation in adapted sport has a positive effect on bone health in athletes with unilateral lower limb amputation but is not sufficient to maintain adequate levels of bone mineralization at the impaired hip in athletes with above-knee amputation. Accordingly, physical conditioners should consider implementing sporting programs, according to the severity of the impairment, aimed at improving bone mineralization at the impaired hip and improve body composition in the residual impaired leg.

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Characteristics and outcomes of hip fractures in lower limb amputees

Cited by 11 publications

References 15 publications

Association Between Combat‐Related Traumatic Injury and Skeletal Health: Bone Mineral Density Loss Is Localized and Correlates With Altered Loading in Amputees: the Armed Services Trauma Rehabilitation Outcome (ADVANCE) Study

Association Between Combat‐Related Traumatic Injury and Skeletal Health: Bone Mineral Density Loss Is Localized and Correlates With Altered Loading in Amputees: the Armed Services Trauma Rehabilitation Outcome (ADVANCE) Study

The experience of sensorimotor integration of a lower limb sensory neuroprosthesis: A qualitative case study

Sporting activity does not fully prevent bone demineralization at the impaired hip in athletes with amputation

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