Deployment after limb salvage for high-energy lower-extremity trauma

Patzkowski, Jeanne C.; Owens, Johnny G.; Blanck, Ryan V.; Kirk, Kevin L.; Hsu, Joseph R.

doi:10.1097/ta.0b013e3182606291

Cited by 24 publications

(12 citation statements)

References 7 publications

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“…While it may not be possible or wise to attempt continued limb salvage on an extremity that continues to have complications or a worsening condition, the decision for amputation is not always driven by medical necessity but by patient desire for a different functional outcome. Advances in limb salvage rehabilitation in combination with our data contributing to the mounting evidence that late amputation does not remedy the burden of severe extremity trauma should shift the perception that some limbs that could continue on the limb salvage pathway [24][25][26]. Soft tissue and osseous infections accounted for over 25% and 35% of all complications in the pre-amputation and postamputation time periods, respectively.…”

Section: Discussionmentioning

confidence: 69%

Late amputation may not reduce complications or improve mental health in combat-related, lower extremity limb salvage patients

Krueger

Rivera

Tennent

et al. 2015

Injury

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Section: Discussionmentioning

confidence: 69%

Late amputation may not reduce complications or improve mental health in combat-related, lower extremity limb salvage patients

Krueger

Rivera

Tennent

et al. 2015

Injury

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“…Lower extremity pain is also expected in the LEI population, as pain is common following lower extremity injury, and a primary reason for rehabilitative care and orthotic intervention. [28] Identifying the primary performance limiter for each individual could allow the treating clinician to further focus treatment, with the end goal of returning the individual to their pre-injury level of performance.…”

Section: Discussionmentioning

confidence: 99%

A novel assessment for Readiness Evaluation during Simulated Dismounted Operations: A reliability study

et al. 2019

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ObjectiveTo determine the intersession reliability of the Readiness Evaluation during Simulated Dismounted Operations (REDOp), a novel ecologically-based assessment for injured Service Members, provide minimal detectable change values, and normative reference range values. To evaluate the ability to differentiate performance limitations between able-bodied and injured individuals using the REDOp.DesignRepeated measures design and between group comparison.SettingOutpatient rehabilitative care setting.ParticipantsService Members who were able-bodied (n = 32) or sustained a traumatic lower extremity injury (n = 22).InterventionsDuring the REDOp, individuals walked over variable terrain as speed and incline progressively increased; they engaged targets; and carried military gear.Main outcome measuresEndurance measured using total distance traveled; walking stability measured using range of full-body angular momentum; and shooting accuracy, precision, reaction time and acquisition time.ResultsIntersession reliability analyses were conducted on a sub-group of 18 able-bodied Service Members. Interclass correlation coefficient values were calculated for distance traveled (0.91), range of angular momentum about three axes (0.78–0.93), shooting accuracy (0.61), precision (0.47), reaction time (0.21), and acquisition time (0.77). Service Members with lower extremity injury demonstrated significantly less distance traveled with a median distance of 0.89 km compared to 2.73 km for the able-bodied group (p < 0.001). Service Members with lower extremity injury demonstrated significantly less stability in the frontal and sagittal planes than the able-bodied group (p < 0.001). The primary performance limiter was endurance followed by pain for both groups. There was no evidence of ceiling effects.ConclusionsThe REDOp is a highly reliable, military-relevant assessment that can be used to measure performance and identify deficits across the domains of activity tolerance, gait stability, and shooting performance.

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“…Military-specific outcomes are of value because of the tremendous cost and residual disability following war injury experienced by otherwise healthy young service members [ 15 ]. Deployment presents substantial physical demands and the ability to deploy implies a high level of physical function [ 16 ]. In contrast to deployment following amputation, return to duty following amputation is often in a different role which may be less demanding.…”

Section: Discussionmentioning

confidence: 99%

Combat-related bridge synostosis versus traditional transtibial amputation: comparison of military-specific outcomes

Plucknette¹,

Krueger²,

Rivera³

et al. 2015

Strategies in Trauma and Limb Reconstruction

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The aim of our study was to determine military-specific outcomes for transtibial amputations of US Service members using either the traditional technique (Burgess) or the Ertl technique. All US Service members sustaining transtibial, combat-related amputation from September 2001 through July 2011 were reviewed. Amputation type, mechanism of injury, time interval to amputation, age, sex, branch of service, rank, force, nature, and injury severity score were recorded. Outcomes were determined by analyzing military-specific medical review results, to include the following: Physical Evaluation Board Liaison Office (PEBLO) rating (0–100), PEBLO outcome (permanent retirement, temporary disability retirement, separation without benefits, continuation of active duty, or fit for redeployment), and the rate of redeployment. Amputation type (Ertl vs. Burgess) was determined by reviewing postoperative radiographs and radiology reports. Data from all of the above categories were compared for both Ertl and Burgess amputees. Of 512 subjects identified, 478 had radiographs or radiology reports distinguishing between Ertl or Burgess transtibial amputation. A total of 406 subjects underwent the Burgess procedure, and 72 subjects underwent the Ertl procedure. There was not a significant difference between the two groups in review board rating (p = 0.858), review board outcome (p = 0.102), or ability to deploy (p = 0.106); however, subjects that underwent the Ertl procedure remained on active duty at a significantly higher rate (p = 0.021). There is a higher rate of remaining on active duty using the Ertl technique. This study suggests that there is an improvement in functional outcome with the Ertl technique.Electronic supplementary materialThe online version of this article (doi:10.1007/s11751-015-0240-4) contains supplementary material, which is available to authorized users.

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Deployment after limb salvage for high-energy lower-extremity trauma

Abstract: Returning to high-level physical function after HELET is challenging. After implementation of the RTR clinical pathway with the intrepid dynamic exoskeletal orthosis, 19.5% of wounded warriors treated with the RTR have been deployed or will be deployed in the coming year.

Cited by 24 publications

References 7 publications

Late amputation may not reduce complications or improve mental health in combat-related, lower extremity limb salvage patients

Late amputation may not reduce complications or improve mental health in combat-related, lower extremity limb salvage patients

A novel assessment for Readiness Evaluation during Simulated Dismounted Operations: A reliability study

Combat-related bridge synostosis versus traditional transtibial amputation: comparison of military-specific outcomes

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