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Doshi TL, Sandbrink F, Cohen SP. Postamputation limb pain in military personnel: separate but equal or separate and never equal? Pain 2024; 165:723-724. [PMID: 38112618 DOI: 10.1097/j.pain.0000000000003095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Tina L Doshi
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Friedhelm Sandbrink
- Department of Neurology, Washington Veterans Affairs Medical Center, Washington, DC, United States
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
- Department of Neurology, George Washington University School of Medicine, Washington, DC, United States
| | - Steven P Cohen
- Departments of Anesthesiology and Critical Care Medicine, Neurology, Physical Medicine and Rehabilitation and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Department of Physical Medicine and Rehabilitation and Anesthesiology, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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2
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Dizon LML, Leochico CFD, Ramirez RS, Rey-Matias RR. A scoping review on upper extremity prostheses: Satisfaction, barriers, and their implications in resource-limited countries. Prosthet Orthot Int 2024:00006479-990000000-00235. [PMID: 38517392 DOI: 10.1097/pxr.0000000000000347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 02/01/2024] [Indexed: 03/23/2024]
Abstract
The rates of prosthetic abandonment are not extensively understood especially in resource-limited countries. A scoping review was conducted to examine the literature on the satisfaction with and barriers to using specifically upper limb prostheses. A systematic search of the literature identified 425 studies. After reviewing the articles using predetermined inclusion and exclusion criteria, 7 cross-sectional studies were included in the final review. Barriers to the use of upper limb prostheses include the characteristics of the prosthesis (type, comfort, weight, functionality, price, and availability) and individual patient factors (recent prosthetic user, level of amputation, congenital and accidental limb loss, pain, and duration between amputation and prosthetic fitting). Considering tailored prosthetic design and funding may result in improved prosthetic adherence.
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Affiliation(s)
- Lorenzo Martin L Dizon
- Department of Physical Medicine and Rehabilitation, St. Luke's Medical Center, Quezon City, Philippines
| | - Carl Froilan D Leochico
- Department of Physical Medicine and Rehabilitation, St. Luke's Medical Center, Quezon City, Philippines
- Department of Physical Medicine and Rehabilitation, St. Luke's Medical Center, Global City, Philippines
- Department of Rehabilitation Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
- Department of Medicine (Division of Neurology) and Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Reykjavik S Ramirez
- Department of Physical Medicine and Rehabilitation, St. Luke's Medical Center, Quezon City, Philippines
- Department of Rehabilitation Medicine, Allied Care Experts Medical Center, Quezon City, Philippines
- Department of Rehabilitation Medicine, Allied Care Experts Medical Center, Valenzuela City, Philippines
| | - Reynaldo R Rey-Matias
- Department of Physical Medicine and Rehabilitation, St. Luke's Medical Center, Quezon City, Philippines
- Department of Physical Medicine and Rehabilitation, St. Luke's Medical Center, Global City, Philippines
- Department of Rehabilitation Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
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3
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De Mori A, Karali A, Daskalakis E, Hing R, Da Silva Bartolo PJ, Cooper G, Blunn G. Poly-ε-Caprolactone 3D-Printed Porous Scaffold in a Femoral Condyle Defect Model Induces Early Osteo-Regeneration. Polymers (Basel) 2023; 16:66. [PMID: 38201731 PMCID: PMC10780383 DOI: 10.3390/polym16010066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/17/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Large bone reconstruction following trauma poses significant challenges for reconstructive surgeons, leading to a healthcare burden for health systems, long-term pain for patients, and complex disorders such as infections that are difficult to resolve. The use of bone substitutes is suboptimal for substantial bone loss, as they induce localized atrophy and are generally weak, and unable to support load. A combination of strong polycaprolactone (PCL)-based scaffolds, with an average channel size of 330 µm, enriched with 20% w/w of hydroxyapatite (HA), β-tricalcium phosphate (TCP), or Bioglass 45S5 (Bioglass), has been developed and tested for bone regeneration in a critical-size ovine femoral condyle defect model. After 6 weeks, tissue ingrowth was analyzed using X-ray computed tomography (XCT), Backscattered Electron Microscopy (BSE), and histomorphometry. At this point, all materials promoted new bone formation. Histological analysis showed no statistical difference among the different biomaterials (p > 0.05), but PCL-Bioglass scaffolds enhanced bone formation in the center of the scaffold more than the other types of materials. These materials show potential to promote bone regeneration in critical-sized defects on load-bearing sites.
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Affiliation(s)
- Arianna De Mori
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, St. Michael’s Building, White Swan Road, Portsmouth PO1 2DT, UK
| | - Aikaterina Karali
- Zeiss Global Centre, School of Mechanical and Design Engineering, University of Portsmouth, Portsmouth PO1 3DJ, UK
| | - Evangelos Daskalakis
- School of Mechanical, Aerospace and Civil Engineering, University of Manchester, Manchester M13 9PL, UK (G.C.)
| | - Richard Hing
- School of Earth and Environmental Sciences, University of Portsmouth, Portsmouth PO1 2HB, UK
| | | | - Glen Cooper
- School of Mechanical, Aerospace and Civil Engineering, University of Manchester, Manchester M13 9PL, UK (G.C.)
| | - Gordon Blunn
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, St. Michael’s Building, White Swan Road, Portsmouth PO1 2DT, UK
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Graham EM, Baschuk CM, Atkins DJ, Hutchinson L, Duncan CC, Mendenhall SD. Hand Surgeons' Understanding of Partial Hand Prostheses: Results of a National Survey Study. Hand (N Y) 2023; 18:1156-1168. [PMID: 35081822 PMCID: PMC10798212 DOI: 10.1177/15589447211068185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Partial hand amputations are devastating injuries that often negatively affect individuals and communities. Partial hand prostheses can mitigate the burdens of living with an amputation, especially when reconstruction alone cannot restore form or function. However, hand surgeons may be unfamiliar with these newer devices because the prosthetic field is rapidly progressing. METHODS An electronic survey was distributed to hand surgeon members of the American Association for Hand Surgery with the intent of assessing surgeons' familiarity with partial hand prosthetic devices and their clinical applications. Survey items used Likert 5-point scales, rank order, multiple-choice, and yes/no question formats. Responses were compared by training background (orthopedic or plastic surgery) and by years of experience (≤10 years in practice or >10 years in practice). RESULTS Overall, hand surgeons are unfamiliar with modern partial hand prosthetic devices. Most of the cohort denied working within a multidisciplinary hand team (76.2%) or consulting with a prosthetist prior to revisional surgeries (71.4%). Restoring gross motor function and reducing pain were important outcomes to the cohort (4.42 and 4.17, respectively). Plastic trained hand surgeons were more likely to list toe-to-hand transfers as treatment options for multilevel digital amputations (P = .03) and transmetacarpal amputations (P = .02). Senior hand surgeons were more likely to suggest no treatment for partial thumb amputations (P = .02). CONCLUSIONS Expanding surgeon knowledge and encouraging collaboration within a multidisciplinary team may enhance amputee care.
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Affiliation(s)
- Emily M. Graham
- The Children’s Hospital of Philadelphia, PA, USA
- Division of Plastic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, USA
| | | | - Diane J. Atkins
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Lana Hutchinson
- Department of Occupational Hand Therapy, University of Utah, Salt Lake City, USA
| | - Christopher C. Duncan
- Division of Plastic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, USA
| | - Shaun D. Mendenhall
- The Children’s Hospital of Philadelphia, PA, USA
- Division of Plastic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, USA
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Essien SK, Linassi AG, Farnan C, Collins K, Zucker-Levin A. The influence of primary and subsequent limb amputation on the overall rate of limb amputation in Saskatchewan, Canada, 2006-2019: a population-based study. BMC Surg 2021; 21:385. [PMID: 34717614 PMCID: PMC8557533 DOI: 10.1186/s12893-021-01381-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 10/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Understanding trends in limb amputation (LA) can provide insight into the prevention and optimization of health care delivery. We examine the influence of primary (first report) and subsequent (multiple reports) limb amputation on the overall (all reports) rate of limb amputation in Saskatchewan considering amputation level. Methods Hospital discharged data associated with LA from 2006 to 2019 and population estimates in Saskatchewan were used. LA cases were grouped based on overall, primary, and subsequent LA and further divided by level into major (through/above the ankle/wrist) and minor (below the ankle/wrist). Incidence rates were calculated using LA cases as the numerator and resident population as the denominator. Joinpoint and negative binomial were used to analyze the trends. In addition, the top three amputation predisposing factors (APF) were described by LA groups. Results The rate of overall LA and primary LA remained stable (AAPC − 0.9 [95% CI − 3.9 to 2.3]) and (AAPC −1.9 [95% CI −4.2 to 0.4]) respectively, while the rate of subsequent LA increased 3.2% (AAPC 3.2 [95% CI 3.1 to 9.9]) over the 14-year study period. The rate of overall major LA declined 4.6% (AAPC − 4.6 [95% CI −7.3 to −1.7]) and was largely driven by the 5.9% decline in the rate of primary major LA (AAPC − 5.9 [95% CI − 11.3 to –0.2]). Subsequent major LA remained stable over the study period (AAPC −0.4 [95% CI − 6.8 to 6.5]). In contrast, the overall rate of minor LA increased 2.0% (AAPC 2.0 [95% CI 1.0 to 2.9]) over the study period which was largely driven by a 9.6% increase in the rate of subsequent minor LA (AAPC 9.6 [95% CI 4.9 to 14.4]). Primary minor LA rates remained stable over the study period (AAPC 0.6 [95% CI − 0.2 to 1.5]). The study cohorts were 1.3-fold greater risk of minor LA than major LA. Diabetes mellitus (DM) was the leading APF representing 72.8% of the cohort followed by peripheral vascular disease (PVD) and trauma with 17.1 and 10.1% respectively. Most (86.7%) of subsequent LA were performed on people with DM. Conclusions Overall LA rates remained stable over the study period with declining rates of major LA countered by rising rates of minor LA. Minor LA exceeded major LA with the largest rate increase identified in subsequent minor LA. Diabetes was the greatest APF for all LA groups. This rising rate of more frequent and repeated minor LA may reflect changing intervention strategies implemented to maintain limb function. The importance of long-term surveillance to understand rates of major and minor LA considering primary and subsequent intervention is an important step to evaluate and initiate prevention and limb loss management programs.
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Affiliation(s)
- Samuel Kwaku Essien
- School of Rehabilitation Science, University of Saskatchewan, Health Science Building, E-Wing, Suite 3400, 3rd Floor, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada.
| | - A Gary Linassi
- Department of Physical Medicine and Rehabilitation, University of Saskatchewan, Saskatoon, SK, S7K 0M7, Canada
| | - Colin Farnan
- Patient-Oriented Team (PORT), 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada
| | - Kassondra Collins
- School of Rehabilitation Science, University of Saskatchewan, Health Science Building, E-Wing, Suite 3400, 3rd Floor, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada
| | - Audrey Zucker-Levin
- School of Rehabilitation Science, University of Saskatchewan, Health Science Building, E-Wing, Suite 3400, 3rd Floor, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada
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6
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Doshi TL, Dworkin RH, Polomano RC, Carr DB, Edwards RR, Finnerup NB, Freeman RL, Paice JA, Weisman SJ, Raja SN. AAAPT Diagnostic Criteria for Acute Neuropathic Pain. PAIN MEDICINE 2021; 22:616-636. [PMID: 33575803 DOI: 10.1093/pm/pnaa407] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Acute neuropathic pain is a significant diagnostic challenge, and it is closely related to our understanding of both acute pain and neuropathic pain. Diagnostic criteria for acute neuropathic pain should reflect our mechanistic understanding and provide a framework for research on and treatment of these complex pain conditions. METHODS The Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) public-private partnership with the U.S. Food and Drug Administration (FDA), the American Pain Society (APS), and the American Academy of Pain Medicine (AAPM) collaborated to develop the ACTTION-APS-AAPM Pain Taxonomy (AAAPT) for acute pain. A working group of experts in research and clinical management of neuropathic pain was convened. Group members used literature review and expert opinion to develop diagnostic criteria for acute neuropathic pain, as well as three specific examples of acute neuropathic pain conditions, using the five dimensions of the AAAPT classification of acute pain. RESULTS AAAPT diagnostic criteria for acute neuropathic pain are presented. Application of these criteria to three specific conditions (pain related to herpes zoster, chemotherapy, and limb amputation) illustrates the spectrum of acute neuropathic pain and highlights unique features of each condition. CONCLUSIONS The proposed AAAPT diagnostic criteria for acute neuropathic pain can be applied to various acute neuropathic pain conditions. Both the general and condition-specific criteria may guide future research, assessment, and management of acute neuropathic pain.
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Affiliation(s)
- Tina L Doshi
- Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Robert H Dworkin
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, and Department of Neurology, Center for Human Experimental Therapeutics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Rosemary C Polomano
- Division of Biobehavioral Health Sciences, University of Pennsylvania-School of Nursing, Philadelphia, Pennsylvania, USA
| | - Daniel B Carr
- Public Health and Community Medicine Program, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nanna B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, and Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Roy L Freeman
- Center for Autonomic and Peripheral Nerve Disorders, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Judith A Paice
- Cancer Pain Program, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Steven J Weisman
- Jane B. Pettit Pain and Headache Center, Children's Wisconsin, Departments of Anesthesiology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Srinivasa N Raja
- Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Rankin IA, Nguyen TT, McMenemy L, Clasper JC, Masouros SD. The Injury Mechanism of Traumatic Amputation. Front Bioeng Biotechnol 2021; 9:665248. [PMID: 33937220 PMCID: PMC8082077 DOI: 10.3389/fbioe.2021.665248] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 03/30/2021] [Indexed: 11/13/2022] Open
Abstract
Traumatic amputation has been one of the most defining injuries associated with explosive devices. An understanding of the mechanism of injury is essential in order to reduce its incidence and devastating consequences to the individual and their support network. In this study, traumatic amputation is reproduced using high-velocity environmental debris in an animal cadaveric model. The study findings are combined with previous work to describe fully the mechanism of injury as follows. The shock wave impacts with the casualty, followed by energised projectiles (environmental debris or fragmentation) carried by the blast. These cause skin and soft tissue injury, followed by skeletal trauma which compounds to produce segmental and multifragmental fractures. A critical injury point is reached, whereby the underlying integrity of both skeletal and soft tissues of the limb has been compromised. The blast wind that follows these energised projectiles completes the amputation at the level of the disruption, and traumatic amputation occurs. These findings produce a shift in the understanding of traumatic amputation due to blast from a mechanism predominately thought mediated by primary and tertiary blast, to now include secondary blast mechanisms, and inform change for mitigative strategies.
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Affiliation(s)
- Iain A Rankin
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Thuy-Tien Nguyen
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Louise McMenemy
- Department of Bioengineering, Imperial College London, London, United Kingdom.,Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre, Birmingham Research Park, Birmingham, United Kingdom
| | - Jonathan C Clasper
- Department of Bioengineering, Imperial College London, London, United Kingdom.,Department of Trauma and Orthopaedic Surgery, Frimley Park Hospital, Surrey, United Kingdom
| | - Spyros D Masouros
- Department of Bioengineering, Imperial College London, London, United Kingdom
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Incidence and demographic characteristics of Syrian Civil War-related amputations: A multi-center study. Turk J Phys Med Rehabil 2021; 67:48-55. [PMID: 33948543 PMCID: PMC8088804 DOI: 10.5606/tftrd.2021.5058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/18/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives The aim of this study was to identify the causes, levels, and rates of amputations performed in civilians during the Syrian Civil War and to present epidemiological data of the amputees. Patients and methods Between August 2017 and February 2019, a total of 363 amputations of 307 amputees (266 males, 41 females; mean age 29.9±13.3 years; range, 6 to 86 years) were retrospectively analyzed in four prosthesis and orthosis centers managed by an international non-governmental organization and serving to individuals who experienced amputation during Syrian Civil War. Level, etiology, number of amputations and distribution of the amputations by years were investigated. Results Of the patients, 25.4% were under the age of 18 years. A total of 74% of all amputations were of the lower extremities. Transtibial and transfemoral amputations were the most common amputation levels. Of the amputees, 89.3% reported the cause of amputation as bombing. Conclusion Civil amputations during the Syrian Civil War are different from those in other civil wars due to the high rate of bombing-induced amputations and also the high rate of victims under the age of 18 years. Our study results show a high ratio of both lower and upper extremity amputations in these civilians.
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Graham EM, Hendrycks R, Baschuk CM, Atkins DJ, Keizer L, Duncan CC, Mendenhall SD. Restoring Form and Function to the Partial Hand Amputee: Prosthetic Options from the Fingertip to the Palm. Hand Clin 2021; 37:167-187. [PMID: 33198915 DOI: 10.1016/j.hcl.2020.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Partial hand amputations are the most common upper extremity amputations and affect individuals across a spectrum of socioeconomic and geographic backgrounds. Prosthetic devices can provide straightforward solutions to the devastating aesthetic, functional, psychological, and social deficits caused by these injuries. However, because of the recent development of multiple partial hand prosthetic devices, many hand providers remain unaware of their applicability in practice. This article highlights the various classes of partial hand prostheses currently available, including passive functional, body-powered, and externally powered options. Familiarity with these partial hand prostheses will better enable providers to care for partial hand amputees.
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Affiliation(s)
- Emily M Graham
- Division of Plastic Surgery, Department of Surgery, University of Utah School of Medicine, 30 North 1900 East Room 3B400, Salt Lake City, UT 84132, USA
| | - Russell Hendrycks
- Division of Plastic Surgery, Department of Surgery, University of Utah School of Medicine, 30 North 1900 East Room 3B400, Salt Lake City, UT 84132, USA
| | | | - Diane J Atkins
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Lana Keizer
- Department of Occupational Hand Therapy, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Christopher C Duncan
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT, USA; Craig H. Neilsen Rehabilitation Hospital, 85 North Medical Drive, Salt Lake City, UT 84132, USA
| | - Shaun D Mendenhall
- Division of Plastic Surgery, Department of Surgery, University of Utah School of Medicine, 30 North 1900 East Room 3B400, Salt Lake City, UT 84132, USA.
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Effects of hyperbaric oxygen therapy on vascular endothelial growth factor protein and mRNA in crush injury patients: A randomized controlled trial study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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11
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Abbas RL, Cooreman D, Al Sultan H, El Nayal M, Saab IM, El Khatib A. The Effect of Adding Virtual Reality Training on Traditional Exercise Program on Balance and Gait in Unilateral, Traumatic Lower Limb Amputee. Games Health J 2021; 10:50-56. [DOI: 10.1089/g4h.2020.0028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rami L. Abbas
- Physical Therapy Department, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Didier Cooreman
- International Committee of the Red Cross (ICRC), Geneva, Switzerland
| | - Hala Al Sultan
- International Committee of the Red Cross (ICRC), Geneva, Switzerland
| | - Mayssah El Nayal
- Department of Psychology, Faculty of Human Sciences, Beirut Arab University, Beirut, Lebanon
| | - Ibtissam M. Saab
- Physical Therapy Department, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Ayman El Khatib
- Physical Therapy Department, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
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Cleaning Up the MESS: Can Machine Learning Be Used to Predict Lower Extremity Amputation after Trauma-Associated Arterial Injury? J Am Coll Surg 2020; 232:102-113.e4. [PMID: 33022402 DOI: 10.1016/j.jamcollsurg.2020.09.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Thirty years after the Mangled Extremity Severity Score was developed, advances in vascular, trauma, and orthopaedic surgery have rendered the sensitivity of this score obsolete. A significant number of patients receive amputation during subsequent admissions, which are often missed in the analysis of amputation at the index admission. We aimed to identify risk factors for and predict amputation on initial admission or within 30 days of discharge (peritraumatic amputation [PTA]). STUDY DESIGN The Nationwide Readmission Database for 2016 and 2017 was used in our analysis. Factors associated with PTA were identified. We used XGBoost, random forest, and logistic regression methods to develop a framework for machine learning-based prediction models for PTA. RESULTS We identified 1,098 adult patients with traumatic lower extremity fracture and arterial injuries; 206 underwent amputation. One hundred and seventy-six patients (85.4%) underwent amputation during the index admission and 30 (14.6%) underwent amputation within a 30-day readmission period. After identifying factors associated with PTA, we constructed machine learning models based on random forest, XGBoost, and logistic regression to predict PTA. We discovered that logistic regression had the most robust predictive ability, with an accuracy of 0.88, sensitivity of 0.47, and specificity of 0.98. We then built on the logistic regression by the NearMiss algorithm, increasing sensitivity to 0.71, but decreasing accuracy to 0.74 and specificity to 0.75. CONCLUSIONS Machine learning-based prediction models combined with sampling algorithms (such as the NearMiss algorithm in this study), can help identify patients with traumatic arterial injuries at high risk for amputation and guide targeted intervention in the modern age of vascular surgery.
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13
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Rankin IA, Nguyen TT, Carpanen D, Clasper JC, Masouros SD. A New Understanding of the Mechanism of Injury to the Pelvis and Lower Limbs in Blast. Front Bioeng Biotechnol 2020; 8:960. [PMID: 32903553 PMCID: PMC7438440 DOI: 10.3389/fbioe.2020.00960] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/24/2020] [Indexed: 11/13/2022] Open
Abstract
Dismounted complex blast injury (DCBI) has been one of the most severe forms of trauma sustained in recent conflicts. This injury has been partially attributed to limb flail; however, the full causative mechanism has not yet been fully determined. Soil ejecta has been hypothesized as a significant contributor to the injury but remains untested. In this study, a small-animal model of gas-gun mediated high velocity sand blast was used to investigate this mechanism. The results demonstrated a correlation between increasing sand blast velocity and injury patterns of worsening severity across the trauma range. This study is the first to replicate high velocity sand blast and the first model to reproduce the pattern of injury seen in DCBI. These findings are consistent with clinical and battlefield data. They represent a significant change in the understanding of blast injury, producing a new mechanistic theory of traumatic amputation. This mechanism of traumatic amputation is shown to be high velocity sand blast causing the initial tissue disruption, with the following blast wind and resultant limb flail completing the amputation. These findings implicate high velocity sand blast, in addition to limb flail, as a critical mechanism of injury in the dismounted blast casualty.
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Affiliation(s)
- Iain A Rankin
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Thuy-Tien Nguyen
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Diagarajen Carpanen
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Jonathan C Clasper
- Department of Bioengineering, Imperial College London, London, United Kingdom.,Department of Trauma and Orthopaedic Surgery, Frimley Park Hospital, Frimley, United Kingdom
| | - Spyros D Masouros
- Department of Bioengineering, Imperial College London, London, United Kingdom
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14
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Sory DR, Amin HD, Chapman DJ, Proud WG, Rankin SM. Replicating landmine blast loading in cellular in vitro models. Phys Biol 2020; 17:056001. [PMID: 32141440 DOI: 10.1088/1478-3975/ab7d1c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Trauma arising from landmines and improvised explosive devices promotes heterotopic ossification, the formation of extra-skeletal bone in non-osseous tissue. To date, experimental platforms that can replicate the loading parameter space relevant to improvised explosive device and landmine blast wave exposure have not been available to study the effects of such non-physiological mechanical loading on cells. Here, we present the design and calibration of three distinct in vitro experimental loading platforms that allow us to replicate the spectrum of loading conditions recorded in near-field blast wave exposure. We subjected cells in suspension or in a three-dimensional hydrogel to strain rates up to 6000 s-1 and pressure levels up to 45 MPa. Our results highlight that cellular activation is regulated in a non-linear fashion-not by a single mechanical parameter, it is the combined action of the applied mechanical pressure, rate of loading and loading impulse, along with the extracellular environment used to convey the pressure waves. Finally, our research indicates that PO MSCs are finely tuned to respond to mechanical stimuli that fall within defined ranges of loading.
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Affiliation(s)
- David R Sory
- Institute of Shock Physics, Department of Physics, Imperial College London, London SW7 2AZ, United Kingdom. National Heart & Lung Institute, Faculty of Medicine, Imperial College London, London SW7 2AZ, United Kingdom. The Royal British Legion-Centre for Blast Injury Studies, Imperial College London, London SW7 2AZ, United Kingdom
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15
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McMenemy L, Ramasamy A, Sherman K, Mistlin A, Phillip R, Evriviades D, Kendrew J. Direct Skeletal Fixation in bilateral above knee amputees following blast: 2 year follow up results from the initial cohort of UK service personnel. Injury 2020; 51:735-743. [PMID: 31932040 DOI: 10.1016/j.injury.2020.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/31/2019] [Accepted: 01/04/2020] [Indexed: 02/02/2023]
Abstract
AIMS The aim of the study is to evaluate the clinical outcome and complications from the initial cohort of blast injured bilateral lower limb, above knee amputees who underwent Direct Skeletal Fixation (DSF). PATIENTS AND METHODS We undertook a retrospective analysis of a prospective data base identifying patients who had undergone implantation with the Australian Osseointegration Group of Australia-Osseointegration Prosthetic Limb (OGAP-OPL) prosthesis, with minimum 24 months follow up. Patient demographics, injury profile, and polymicrobial colonisation status were recorded. Physical functional performance measures recorded were the 6 minute Walk Test (6-MWT) and patient reported outcome measures were the Short Form Health Survey-36 (SF-36). Post operatively, complications including infection, re-operation, and fracture were recorded. RESULTS 7 patients (14 femora) were identified (mean age 29.8yrs), all injured by dismounted blast. Mean follow up was 46 months. All were polytrauma patients and all had previous polymicrobial colonisation. Following surgery, all patients mobilised with significant improvement in 6-minute walk time, with a mean improvement of 154 m (248 m vs 402 m, p = 0.018). The physical component score for the SF-36 demonstrated a statistically significant improvement from 34.65 to 54.5 (p = 0.018) and the mental component score demonstrated a similar improvement (41.55-58.19 p = 0.018). At follow up, no patient required explantation of the implant. Each had been prescribed a minimum of 1 course of antibiotics with no evidence of deep infection. CONCLUSION DSF is an option for amputees who, due to the nature of their injuries, may not be able to tolerate traditional suspension socket prostheses and have exhausted all other treatment options. At a minimum of 2 year follow up, the absence of significant infective complications suggests DSF may be utilised in the blast injured despite chronic polymicrobial colonisation. Longer term surveillance of these patients is required to assess the long-term suitability of this technique in this cohort of patients.
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Affiliation(s)
- Louise McMenemy
- Centre for Blast Injury Studies, Bessemer Building, Imperial College London, South Kensington Campus, Exhibition Road, London, UK; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre, Birmingham Research Park, Vincent Drive, Birmingham B15 2SQ, UK.
| | - Arul Ramasamy
- Centre for Blast Injury Studies, Bessemer Building, Imperial College London, South Kensington Campus, Exhibition Road, London, UK; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre, Birmingham Research Park, Vincent Drive, Birmingham B15 2SQ, UK.
| | - Kate Sherman
- Defence Medical Rehabilitation Centre, Stanford Hall, Stanford on Soar, Loughborough LE12 5QW, UK.
| | - Alan Mistlin
- Defence Medical Rehabilitation Centre, Stanford Hall, Stanford on Soar, Loughborough LE12 5QW, UK.
| | - Rhodri Phillip
- Defence Medical Rehabilitation Centre, Stanford Hall, Stanford on Soar, Loughborough LE12 5QW, UK; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre, Birmingham Research Park, Vincent Drive, Birmingham B15 2SQ, UK.
| | | | - Jon Kendrew
- Centre for Blast Injury Studies, Bessemer Building, Imperial College London, South Kensington Campus, Exhibition Road, London, UK; Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre, Birmingham Research Park, Vincent Drive, Birmingham B15 2SQ, UK.
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16
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Jeon I, Leigh JH, Ro JS, Ro YS, Lee SH, Shin HI, Bang MS. Trends in the incidence of work-related traumatic limb amputations in South Korea from 2004 to 2013. Prosthet Orthot Int 2019; 43:409-417. [PMID: 30922171 DOI: 10.1177/0309364619838356] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Epidemiological data for work-related traumatic limb amputations are limited worldwide, particularly incidence trends related to workplace characteristics. OBJECTIVES To investigate nationwide incidence rates and trends for amputations according to industry and establishment size. STUDY DESIGN Retrospective cohort study. METHODS Incidence rates were calculated using workers' compensation claims in South Korea from 2004 to 2013. Age-sex standardization was conducted, and trends related to workplace characteristics were statistically analyzed using the chi-square test. RESULTS The overall incidence rate was 38.8 claims per 100,000 workers. Decreasing trends over time in age-sex standardized incidence were observed. Most claims occurred in manufacturing and construction industries. Incidence within the manufacturing decreased significantly (p < 0.001), but not in the construction (p = 0.130) industry. Small-sized establishments (<50 employees) accounted for 77.8% of claims. Incidence in small establishments significantly decreased between 2004 and 2013 (p < 0.001). CONCLUSION A decreasing incidence rate for traumatic amputations in manufacturing and small establishments may imply that preventive measures have been successful in South Korea. If so, these strategies may be useful for other fast-growing Asian economies. Further research is needed to identify the causes of traumatic amputations according to industry and establishment size. CLINICAL RELEVANCE Trends in the incidence rate of work-related traumatic limb amputations related to workplace characteristics can provide useful information for policy makers to improve prevention strategies.
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Affiliation(s)
- Inpyo Jeon
- 1 Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ja-Ho Leigh
- 1 Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,2 Institute of Public Health and Medical Service, Seoul National University Hospital, Seoul, Korea.,3 Medical Rehabilitation Center, Workers' Compensation and Welfare Service Incheon Hospital, Incheon, Korea
| | - Jun-Soo Ro
- 4 Clinical Preventive Medicine Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Sun Ro
- 5 Laboratory of Emergency Medical Services, Seoul National University Hospital, Seoul, Korea
| | - Seung Hak Lee
- 6 Department of Rehabilitation Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Hyung-Ik Shin
- 1 Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Moon Suk Bang
- 1 Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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17
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Sivapuratharasu B, Bull AMJ, McGregor AH. Understanding Low Back Pain in Traumatic Lower Limb Amputees: A Systematic Review. Arch Rehabil Res Clin Transl 2019; 1:100007. [PMID: 33543047 PMCID: PMC7853329 DOI: 10.1016/j.arrct.2019.100007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objective This systematic review aims to evaluate current literature for the prevalence, causes, and effect of low back pain (LBP) in traumatic lower limb amputees, specifically its association with the kinematics and kinetics of the lumbar spine and lower extremities. Data Sources Databases (EMBASE, MEDLINE, Scopus, CINAHL, PsycINFO) were searched systematically for eligible studies from inception to January 2018. Study Selection The inclusion terms were synonyms of low back pain, lower limb amputation, and trauma, whereas studies involving nontraumatic amputee populations, single cases, or reviews were excluded. 1822 studies were initially identified, of which 44 progressed to full-text reading, and 11 studies were included in the review. Data Extraction Two independent reviewers reviewed the included studies, which were evaluated using a quality assessment tool and the Grades of Recommendation, Assessment, Development and Evaluation system for risk of bias, prior to analyzing results and conclusions. Data Synthesis There was an LBP prevalence of 52%-64% in traumatic amputees, compared to 48%-77% in the general amputee population (predominantly vascular, tumor, trauma), attributed to a mixture of biomechanical, psychosocial, and personal factors. These factors determined the presence, frequency, and severity of the pain in the amputees, significantly affecting their quality of life. However, little evidence was available on causality. Conclusion The high prevalence of LBP in traumatic amputees highlights the necessity to advance research into the underlying mechanics behind LBP, specifically the spinal kinematics and kinetics. This may facilitate improvements in rehabilitation, with the potential to improve quality of life in traumatic amputees.
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Affiliation(s)
- Biranavan Sivapuratharasu
- Centre for Blast Injury Studies, Imperial College London, London, United Kingdom.,Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Anthony M J Bull
- Centre for Blast Injury Studies, Imperial College London, London, United Kingdom.,Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Alison H McGregor
- Centre for Blast Injury Studies, Imperial College London, London, United Kingdom.,Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Heszlein-Lossius HE, Al-Borno Y, Shaqqoura S, Skaik N, Giil LM, Gilbert M. Does pain, psychological distress and deteriorated family economy follow traumatic amputation among war casualties? A retrospective, cross-sectional study from Gaza. BMJ Open 2019; 9:e029892. [PMID: 31217319 PMCID: PMC6589021 DOI: 10.1136/bmjopen-2019-029892] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The aim of this study was to explore determinants of psychosocial distress and pain in patients who have survived severe extremity amputation in Gaza. SETTING This study was conducted in a secondary care rehabilitation centre in Gaza, Palestine. The clinic is Gaza's sole provider of artificial limbs. PARTICIPANTS We included 254 civilian Palestinians who had survived but lost one or more limb(s) during military incursions from 2006 to 2016. We included patients with surgically treated amputation injuries who attended physical rehabilitation at a specialist prosthesis centre in Gaza. Amputees with injuries prior to 2006 or non-military related injuries were excluded.We assessed their pain and psychological stress using the General Health Questionnaire (GHQ-12). We used income, amputation severity scored by proximity to torso, current employment status, loss of family members and loss of home as independent variables. RESULTS The amputees median age was 23 years at the time of trauma, while a median of 4.3 years had passed from trauma to study inclusion. Nine of 10 were male, while 43 were children when they were amputated (17%≤18 years). One hundred and ninety-one (75%) were unemployed and 112 (44%) reported unemployment caused by being amputated. Pain was the most frequent problem, and 80 amputees (32%) reported to suffer from daily pain. Family income was significantly correlated with the physical pain (OR=0.54, CI 0.36 to 0.80, p=0.002). Psychological distress was higher among unemployed amputees (OR=1.36, CI 1.07 to 1.72, p=0.011). We found no association between psychological distress (GHQ-scores) and the extent of the initial amputation. CONCLUSION Pain and psychological distress following war-related extremity amputation of one or more limbs correlated stronger with deteriorated family economy and being unemployed than with the anatomical and medical severity of extremity amputations.
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Affiliation(s)
| | - Yahya Al-Borno
- Surgical department, Al-Shifa Hospital, Gaza City, Palestine
| | - Samar Shaqqoura
- Surgical department, Al-Shifa Hospital, Gaza City, Palestine
| | - Nashwa Skaik
- Surgical department, Al-Shifa Hospital, Gaza City, Palestine
| | - Lasse Melvaer Giil
- Department of Internal medicine, Haraldsplass Diakonale Sykehus AS, Bergen, Norway
| | - Mads Gilbert
- Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
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Heszlein-Lossius H, Al-Borno Y, Shaqqoura S, Skaik N, Giil LM, Gilbert MF. Traumatic amputations caused by drone attacks in the local population in Gaza: a retrospective cross-sectional study. Lancet Planet Health 2019; 3:e40-e47. [PMID: 30654867 DOI: 10.1016/s2542-5196(18)30265-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Little data exist to describe the use and medical consequences of drone strikes on civilian populations in war and conflict zones. Gaza is a landstrip within the Palestinian territories and the home of 2 million people. The median age in Gaza is 17·2 years and almost half of the population is below the age of 14 years. We studied the prevalence and severity of extremity amputation injuries caused by drone strikes compared with those caused by other explosive weapons among patients with amputations attending the main physical prosthesis and rehabilitation centre in Gaza. METHODS In this retrospective cross-sectional study, we recruited patients from the Artificial Limb and Polio Centre (ALPC) in Gaza city in the Gaza strip with conflict-related traumatic extremity amputations. Patients were eligible if they had one or more amputations sustained during a military incursion in Gaza during 2006-16 and had an available patient record. Each patient completed a self-reporting questionnaire of the time and mechanism of injury, subsequent surgeries, comorbidities, and their socioeconomic status, and we collected each patient's medical history, recorded the anatomical location of their amputation or amputations, and interviewed each patient to obtain a detailed description of the incursion or incursions that led to their amputation injury. We classified the severity of amputations and number of subsequent surgeries on ordinal scales and then we determined the associations between these outcomes and the mechanism of explosive weapon delivery (drone strike vs other) using ordinal logistical regression. FINDINGS We collected data on 254 patients from APLC who had sustained an amputation injury. Of these patients, 234 (92%) were male and 43 (17%) were aged 18 years or younger at the time of injury. The age of participants was representative of the Gaza population, with a median age at inclusion was 28 years (IQR 23-33), and the median age at the time of injury was 23 years (IQR 20-29). 136 (54%) amputation injuries were caused by explosive weapons delivered by drone strikes, with explosives delivered by tanks being the next most common source of amputation injury (28 [11%]). Adjusted for age and sex, drone-delivered weapons caused significantly more severe injuries than explosives delivered by other mechanisms (eg, military jet airplanes, helicopters, tank shelling, and naval artillery; odds ratio [OR] 2·50, 95% CI 1·52-4·11; p=0·0003). Compared with all other types of weapons, the patients whose injuries were caused by drone strikes needed significantly more subsequent surgical operations to treat their amputation injuries than those injured by other weapons (OR 1·93, 1·19-3·14; p=0·008). INTERPRETATION Drone strikes were the most commonly reported cause of amputation injury in our study population and were associated with more severe injuries and more additional surgeries than injuries caused by other explosive weapons. Limitations of our study include the self-reported nature of the mechanism of injury and number of subsequent surgeries and selection bias from not incorporating amputation injuries from individuals who died immediately or due to complications. The increasing use of drones needs to be addressed, rather than passively accepted, by the international community. This study fills a gap in our knowledge of the civilian consequences of modern warfare and we believe it is also relevant to the growing populations that are being exposed to drone warfare and for health-care personnel treating these people. FUNDING None.
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Affiliation(s)
- Hanne Heszlein-Lossius
- The Anaesthesia and Critical Care Research Group, Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway.
| | - Yahya Al-Borno
- All Al-Shifa Medical Centre, Gaza Strip, occupied Palestinian territory
| | - Samar Shaqqoura
- All Al-Shifa Medical Centre, Gaza Strip, occupied Palestinian territory
| | - Nashwa Skaik
- All Al-Shifa Medical Centre, Gaza Strip, occupied Palestinian territory
| | - Lasse Melvaer Giil
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Mads F Gilbert
- The Anaesthesia and Critical Care Research Group, Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
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20
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Heszlein-Lossius HE, Al-Borno Y, Shaqqoura S, Skaik N, Giil LM, Gilbert M. Life after conflict-related amputation trauma: a clinical study from the Gaza Strip. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2018; 18:34. [PMID: 30170582 PMCID: PMC6119320 DOI: 10.1186/s12914-018-0173-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 08/22/2018] [Indexed: 11/23/2022]
Abstract
Background More than 17.000 Palestinians were injured during different Israeli military incursions on the Gaza Strip from 2006 to 2014. Many suffered traumatic extremity amputations. We describe the injuries, complications, living conditions and health among a selection of traumatic amputees in the Gaza Strip. Methods We included 254 civilian Palestinians who had survived, but lost one or more limb(s) during military incursions from 2006 to 2016. All patients were receiving follow-up treatment at a physical rehabilitation center in Gaza at the time of inclusion. We measured and photographed anatomical location and length of extremity amputations and interviewed the amputees using standard questionnaires on self-reported health, socioeconomic status, mechanism of injury, physical status and medical history. Results The amputees were young (median age 25,6 years at the time of trauma), well educated (37% above graduate level), males (92%), but also 43 children (17% ≤ 18 years). The greater part suffered major amputations (85% above wrist or ankle). Limb losses were unilateral (35% above-, 29·5% below knee), and bilateral (17%) lower extremity amputations. Pain was the most frequent long-term complaint (in joints; 34%, back; 33% or phantom pain; 40·6%). Sixty-three percent of amputees were their family’s sole breadwinner, 75·2% were unemployed and 46% had lost their home. Only one in ten (11·6%) of the destroyed homes had been rebuilt. Conclusions The most frequently observed amputees in our study were young, well-educated male breadwinners and almost one in five were children. Conflict-related traumatic amputations have wide-ranging, serious consequences for the amputees and their families.
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Affiliation(s)
- Hanne Edøy Heszlein-Lossius
- The Anaesthesia and Critical Care Research Group, Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway. .,UiT The Arctic University of Norway, Tromsø, Norway.
| | | | | | - Nashwa Skaik
- Al-Shifa Medical Centre, Gaza Strip, Gaza, Palestine
| | - Lasse Melvaer Giil
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Mads Gilbert
- The Anaesthesia and Critical Care Research Group, Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway.,Clinic of Emergency Medicine, University Hospital of North Norway, Tromsø, Norway
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Krawczyk P, Włoch T, Pirowska A, Śliwka A, Piliński R, Maga P, Golec E, Nowobilski R. Phantom phenomena in limb amputees – a review article. REHABILITACJA MEDYCZNA 2018. [DOI: 10.5604/01.3001.0010.8083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Amputation leading to the loss of a body part is associated not only with significant economic costs, but also serious consequences of medical and socio-psychological nature. It is the ultimate means to save a life or improve its quality. The most difficult challenges faced by amputees include accepting changes regarding their own physiognomy and the resulting life restrictions. The patient subjected to amputation is faced with an extremely difficult adaptation process, during which s/he should strive for a maximum degree of independence. Unfortunately, a large group of patients also struggles with various types of sensations and pain located within the lost limb − i.e., so-called phantom phenomena. This is a special group of phenomena of diverse nature, “located” within the lost limb. The occurrence of phantom limb syndrome in amputee patients is extremely common. This problem affects from 45% to even 98% of patients after amputation of one or both upper and lower limbs. The main purpose of this article is to describe phantom phenomena observed in patients after limb amputation in light of current literature. The definition, historical outline, types of phantom phenomena are presented, as well as hypothetical pathomechanisms, factors influencing the frequency and intensity of phantom phenomena and available treatment methods. The work was based on numerous text sources and the author’s own experience.
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Affiliation(s)
- Paweł Krawczyk
- Zakład Rehabilitacji w Chorobach Wewnętrznych, Instytut Fizjoterapii, Wydział Nauk o Zdrowiu, UJCM / Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - Tomasz Włoch
- Zakład Rehabilitacji w Chorobach Wewnętrznych, Katedra Rehabilitacji Klinicznej, Akademia Wychowania Fizycznego w Krakowie / Department of Rehabilitation in Internal Diseases, University of Physical Education, Krakow, Poland
| | - Aneta Pirowska
- Institut Robert Merle d'Aubigné, Artificial Limb Centre (Centre de Rééducation et d'Appareillage), Valenton, France
| | - Agnieszka Śliwka
- Zakład Rehabilitacji w Chorobach Wewnętrznych, Instytut Fizjoterapii, Wydział Nauk o Zdrowiu, UJCM / Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - Rafał Piliński
- Zakład Rehabilitacji w Chorobach Wewnętrznych, Instytut Fizjoterapii, Wydział Nauk o Zdrowiu, UJCM / Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - Paweł Maga
- Klinika Angiologii UJCM / Department of Angiology, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - Edward Golec
- Zakład Rehabilitacji w Ortopedii, Katedra Rehabilitacji Klinicznej, Akademia Wychowania Fizycznego w Krakowie / Department of Rehabilitation in Orthopaedics, Faculty of Motor Rehabilitation, University School of Physical Education, Krakow, Poland
| | - Roman Nowobilski
- Zakład Rehabilitacji w Chorobach Wewnętrznych, Instytut Fizjoterapii, Wydział Nauk o Zdrowiu, UJCM / Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Collegium Medicum, Krakow, Poland
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Christensen J, Langberg H, Doherty P, Egerod I. Ambivalence in rehabilitation: thematic analysis of the experiences of lower limb amputated veterans. Disabil Rehabil 2017. [DOI: 10.1080/09638288.2017.1342281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jan Christensen
- Department of Occupational and Physiotherapy, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Public Health, Section of Social Medicine, Faculty of Health, CopenRehab, University of Copenhagen, Copenhagen, Denmark
| | - Henning Langberg
- Department of Occupational and Physiotherapy, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Ingrid Egerod
- Neurointensive Care Unit, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Guermazi A, Hayashi D, Smith SE, Palmer W, Katz JN. Imaging of blast injuries to the lower extremities sustained in the Boston marathon bombing. Arthritis Care Res (Hoboken) 2014; 65:1893-8. [PMID: 24039123 DOI: 10.1002/acr.22113] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 08/07/2013] [Indexed: 01/31/2023]
Affiliation(s)
- Ali Guermazi
- Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
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