The Mangled Foot and Leg: Salvage Versus Amputation

Shawen, Scott B.; Keeling, John J.; Branstetter, Joanna G.; Kirk, Kevin L.; Ficke, James R.

doi:10.1016/j.fcl.2009.11.005

Cited by 59 publications

(33 citation statements)

References 28 publications

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“…These extremity injuries are often the result of explosive mechanisms (52%), gunshots (16%), or mortar attacks (9%) [30]. Advances in surgical procedures [34] and rehabilitation [7,31,32] have improved the ability to salvage the limb and restore function after severe injury. Limb salvage, or reconstruction, is a viable treatment option for many patients with severe limb trauma who would otherwise undergo amputation [34].…”

Section: Introductionmentioning

confidence: 99%

“…Advances in surgical procedures [34] and rehabilitation [7,31,32] have improved the ability to salvage the limb and restore function after severe injury. Limb salvage, or reconstruction, is a viable treatment option for many patients with severe limb trauma who would otherwise undergo amputation [34]. However, many patients still are unable to return to full functional capacity as a result of muscle loss [17], instability, stiffness, chronic pain, and peripheral nervous system injury.…”

Section: Introductionmentioning

confidence: 99%

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How Does Ankle-foot Orthosis Stiffness Affect Gait in Patients With Lower Limb Salvage?

Esposito

Blanck

Harper

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Ankle-foot orthoses (AFOs) are commonly prescribed during rehabilitation after limb salvage. AFO stiffness is selected to help mitigate gait deficiencies. A new custom dynamic AFO, the Intrepid Dynamic Exoskeletal Orthosis (IDEO), is available to injured service members but prescription guidelines are limited. Questions/purposes In this study we ask (1) does dynamic AFO stiffness affect gait parameters such as joint angles, moments, and powers; and (2) can a given dynamic AFO stiffness normalize gait mechanics to noninjured control subjects? Methods Thirteen patients with lower limb salvage (ankle arthrodesis, neuropathy, foot/ankle reconstruction, etc) after major lower extremity trauma and 13 control subjects who had no lower extremity trauma and wore no orthosis underwent gait analysis at a standardized speed. Patients wore their custom IDEO with posterior struts of three different stiffnesses: nominal (clinically prescribed stiffness), compliant (20% less stiff), and stiff (20% stiffer). Joint angles, moments, powers, and ground reaction forces were compared across the varying stiffnesses of the orthoses tested and between the patient and control groups. Results An increase in AFO compliance resulted in 20% to 26% less knee flexion relative to the nominal (p = 0.003) and stiff (p = 0.001) conditions, respectively. Ankle range of motion and power generation were, on average, 56% (p \ 0.001) and 63% (p \ 0.001), respectively, less than controls as a result of the relatively fixed ankle position. Conclusions Patients with limb salvage readily adapted to different dynamic AFO stiffnesses and demonstrated few Support was provided by

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

How Does Ankle-foot Orthosis Stiffness Affect Gait in Patients With Lower Limb Salvage?

Esposito

Blanck

Harper

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…69 Chronic pain, nerve damage, and volumetric muscle loss are common barriers to LS rehabilitation and may serve as confounding factors in the development of OA treatment plans. 70,71 Ankle-foot orthoses (AFOs) are commonly used to assist ankle function or offload painful structures. 72 Optional therapies that include sports medicine-based interventions utilizing a dynamic AFO (e.g., the Intrepid Dynamic Exoskeletal Orthosis) are available to LS patients.…”

Section: Osteoarthritismentioning

confidence: 99%

Impact of Traumatic Lower Extremity Injuries Beyond Acute Care: Movement-Based Considerations for Resultant Longer Term Secondary Health Conditions

Butowicz

Dearth

Hendershot

2017

Advances in Wound Care

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Significance: Advances in field-based trauma care, surgical techniques, and protective equipment have collectively facilitated the survival of a historically large number of service members (SMs) following combat trauma, although many sustained significant composite tissue injuries to the extremities, including limb loss (LL) and limb salvage (LS). Beyond the acute surgical and rehabilitative efforts that focus primarily on wound care and restoring mobility, traumatic LL and LS are associated with several debilitating longer term secondary health conditions (e.g., low back pain [LBP], osteoarthritis [OA], and cardiovascular disease [CVD]) that can adversely impact physical function and quality of life. Recent Advances: Despite recent advancements in prosthetic and orthotic devices, altered movement and mechanical loading patterns have been identified among persons with LL and salvage, which are purported risk factors for the development of longer term secondary musculoskeletal conditions and may limit functional outcomes and/or concomitantly impact cardiovascular health. Critical Issues: The increased prevalence of and risk for LBP, OA, and CVD among the relatively young cohort of SMs with LL and LS significantly impact physiological and psychological well-being, particularly over the next several decades of their lives. Future Directions: Longitudinal studies are needed to characterize the onset, progression, and recurrence of health conditions secondary to LL and salvage. While not a focus of the current review, detailed characterization of physiological biomarkers throughout the rehabilitation process may provide additional insight into the current understanding of disease processes of the musculoskeletal and cardiovascular systems.Keywords: amputation, biomechanics, cardiovascular disease, limb salvage, low back pain, osteoarthritis SCOPE AND SIGNIFICANCEExtremity trauma, including limb loss (LL) and limb salvage (LS), is commonly associated with an elevated risk for secondary health conditions (e.g., low back pain [LBP], osteoarthritis [OA], cardiovascular disease [CVD]) that can significantly limit physical function, reduce quality of life (QoL), and life expectancy. This review provides an extensive commentary regarding resultant secondary health effects of extremity trauma in service members (SMs), with a particular focus on functional outcomes and quality of movement. TRANSLATIONAL RELEVANCEPhysiologic biomarkers provide an opportunity to enhance translation in future work to examine the pathophysiology of the secondary health conditions associated with traumatic LL from a basic science perspective. While this approach is yet to be fully explored and thus was not a primary focus of this review, such biomarkers may augment traditional analyses and support more comprehensive risk characterization, thereby allowing clinicians and researchers to better mitigate disease onset or progression. CLINICAL RELEVANCEThe increased prevalence of secondary health effects following traumatic extremity injuries places a...

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“…The fate of the patients amputated was beyond the scope of this study and is reported elsewhere. 28,29 Major foot deformities at the time of follow-up were rare, even if the majority of the patients showed minor residual deformities. In most cases, a flattening of the longitudinal arch and a slightly valgus hindfoot were diagnosed.…”

Section: Discussionmentioning

confidence: 97%