The Military Extremity Trauma Amputation/Limb Salvage (METALS) Study

Doukas, William C.; Hayda, Roman A.; Frisch, H; Andersen, Romney C.; Mazurek, Michael T.; Ficke, James R.; Keeling, John J.; Pasquina, Paul F.; Wain, Harold J.; Carlini, Anthony R.; MacKenzie, Ellen J.

doi:10.2106/jbjs.k.00734

Cited by 248 publications

(82 citation statements)

References 1 publication

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“…Over 20 years ago Giorgiadis, et al suggested that patients with a salvaged limb took longer to full weight-bearing, were less willing to work, had higher hospital charges, were more likely to consider themselves severely disabled, and had more problems with occupational and recreational activities [12]. More recently Doukas, et al (the METALS study) suggested that patients undergoing amputation had better functional outcomes than those undergoing limb salvage [11]. These findings are in contrast to Busse, et al, who performed a meta-analysis of observational studies comparing complex limb-salvage versus early amputation [7].…”

Section: Discussionmentioning

confidence: 99%

“…Several authors report early amputation results in better functional outcomes, lower rates of post-traumatic stress disorder, and a higher likelihood to engage in sporting activities [11,27,31]. In contrast, patients who underwent delayed amputation had significantly higher rates of out-patients visits, wound complications, and infections [27].…”

Section: Introductionmentioning

confidence: 99%

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Functional and psychological outcomes of delayed lower limb amputation following failed lower limb reconstruction

Merwe

Birkholtz

Tetsworth

et al. 2016

Injury

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Purpose:The purpose of this study was to evaluate the functional and psychological outcomes of patients who underwent delayed lower limb amputation following failed limb salvage surgery. Methods:This retrospective, descriptive study evaluated functional outcomes using the Sickness Impact Profile (SIP) and Short Form-36 (SF-36) in 12 patients. Inclusion criteria included patients who underwent limb reconstruction and delayed amputation between between July 2006 and December 2014, with an age range between 18-80 years of age, the ability to ambulate independently, a time interval between the last salvage procedure and amputation greater than six months, and a minimum follow-up of 24 months. Patients were contacted via telephone by the principal investigator and both the Sickness Impact Profile (SIP) and Short Form-36 (SF-36) were completed. Descriptive analysis (means and standard deviation) was used to determine outcomes for both SIP and SF-36 health profiles. Results:Ten patients who had amputations following failed reconstruction (2006-2014) with a mean age of 53+10 years were interviewed. Six patients had a SIP < 5, three patients scored between five and 10 points and one scored >10 points. The main deficit on the SF-36 was in the physical component. The SF-36 scores demonstrated a mean score of 40.8+11.5 for the physical component, and 57.4+7.9 for the mental component. Three patients returned to work after amputation and continued performing their pre-injury duties as farmers.Three other patients returned to work, but were allocated to administrative duties. Two patients were pensioners at the time of their injuries, and the only female patient was a housewife. One patient went into early retirement. Conclusion:The results of this study strongly suggest that delayed amputation following failed limb salvage surgery can still result in good and satisfactory outcomes in the majority of patients and achieves results similar to early amputation and limb reconstruction techniques.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Functional and psychological outcomes of delayed lower limb amputation following failed lower limb reconstruction

Merwe

Birkholtz

Tetsworth

et al. 2016

Injury

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“…It is important to recognize that the similarities observed here and elsewhere, while encouraging, do not represent an absence of dysfunction or the full restoration of function in all people or across all aspects of life. Other deficits are often still present requiring further rehabilitation to restore function and quality of life [42].…”

Section: Russell Esposito Et Al Metabolic Demand Of Walking In Amputeesmentioning

confidence: 99%

Does unilateral transtibial amputation lead to greater metabolic demand during walking?

et al. 2014

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Abstract-Previous literature reports greater metabolic demand of walking following transtibial amputation. However, most research focuses on relatively older, less active, and often dysvascular amputees. Servicemembers with traumatic amputation are typically young, fit, and highly active before and often following surgical amputation of their lower limb. This study compared the metabolic demand of walking in young, active individuals with traumatic unilateral transtibial amputation (TTA) and nondisabled controls. Heart rate (HR), rate of oxygen consumption, and rating of perceived exertion (RPE) were calculated as subjects walked at a self-selected velocity and at five standardized velocities based on leg length. The TTA group completed a Prosthetics Evaluation Questionnaire. Oxygen consumption (p = 0.89), net oxygen consumption (p = 0.32), and RPE (p = 0.14) did not differ between groups. Compared with controls, HR was greater in the TTA group and increased to a greater extent with velocity (p < 0.001). Overall, the TTA group rated their walking abilities as high (mean: 93% out of 100%). This is the first study to report equivalent metabolic demand between persons with amputation and controls walking at the same velocity. These results may reflect the physical fitness of the young servicemembers with traumatic amputations and may serve to guide outcome expectations in the future.

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“…In fact, up to 7-year follow-up of a large cohort of patients following severe lower extremity trauma has revealed no difference in self-reported functional outcome scores between patients who underwent limb salvage procedure versus amputation [113]. In a more recent cohort of 324 service members with severe lower extremity trauma, amputees actually had improved self-reported functional scores a higher likelihood of participating in sporting activities than those who underwent limb salvage [114].…”

Section: Amputationmentioning

confidence: 98%

Clinical Aspects of Fracture Healing: An Overview

Liu

Buza

Leucht

2015

Clinic Rev Bone Miner Metab

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The assessment, diagnosis, and management of fractures, particularly fractures that exhibit delayed healing, present considerable unique challenges to both patients and physicians. Fracture healing results from a complex series of biochemical events that may produce complete restoration of the anatomic and biochemical properties of the original osseous tissue. Fracture healing requires appropriate reduction, mechanical stability, and adequate vascularity to the fracture site; compromise of one of these elements may lead to delayed healing or nonunion. The patient's history, physical examination, and findings based on radiographs or other imaging modalities allow for assessment and characterization of the progression of healing. If nonunion is recognized, it is important for the clinician to understand the current treatment options that are available to optimize healing. Physical stimulation therapies include electromagnetic stimulation and low-intensity pulsed ultrasonography. Osteogenic factors used locally to promote fracture healing include autologous bone marrow and peptide signaling molecules such as platelet-derived growth factors, fibroblast growth factors, and bone morphogenetic proteins. Systemic biological protein such as parathyroid hormone and factors that target the Wnt family of signaling molecules offers promising data regarding its abilities to promote healing. Large segmental defects must be managed depending on the type and severity of the injury and may require treatment with bone grafts, induced membrane techniques, acute shortening, or distraction osteogenesis. A systematic approach in evaluating fracture union and an understanding of the modern methods to promote fracture healing will allow clinicians to significantly improve the treatment of patients with these injuries.

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The Military Extremity Trauma Amputation/Limb Salvage (METALS) Study

Cited by 248 publications

References 1 publication

Functional and psychological outcomes of delayed lower limb amputation following failed lower limb reconstruction

Functional and psychological outcomes of delayed lower limb amputation following failed lower limb reconstruction

Does unilateral transtibial amputation lead to greater metabolic demand during walking?

Clinical Aspects of Fracture Healing: An Overview

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