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Kumar A, Soliman N, Gan Z, Cullinan P, Vollert J, Rice AS, Kemp H. A systematic review of the prevalence of postamputation and chronic neuropathic pain associated with combat injury in military personnel. Pain 2024; 165:727-740. [PMID: 38112578 PMCID: PMC10949216 DOI: 10.1097/j.pain.0000000000003094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 12/21/2023]
Abstract
ABSTRACT Combat trauma can lead to widespread tissue damage and limb loss. This may result in chronic neuropathic and post amputation pain, including phantom limb pain (PLP) and residual limb pain (RLP). The military population is distinct with respect to demographic, injury, and social characteristics compared with other amputation and trauma cohorts. We undertook a systematic review of studies of military personnel, with a history of combat injury, that reported a prevalence of any type of postamputation pain or chronic neuropathic pain, identified from Embase and MEDLINE databases.Using the inverse variance method with a random-effects model, we undertook a meta-analysis to determine an overall prevalence and performed exploratory analyses to identify the effect of the type of pain, conflict, and time since injury on prevalence. Pain definitions and types of pain measurement tools used in studies were recorded. Thirty-one studies (14,738 participants) were included. The pooled prevalence of PLP, RLP, and chronic neuropathic pain were 57% (95% CI: 46-68), 61% (95% CI: 50-71), and 26% (95% CI: 10-54), respectively. Between-study heterogeneity was high (I 2 : 94%-98%). Characterisation of duration, frequency, and impact of pain was limited. Factors reported by included studies as being associated with PLP included the presence of RLP and psychological comorbidity. The prevalence of postamputation pain and chronic neuropathic pain after combat trauma is high. We highlight inconsistency of case definitions and terminology for pain and the need for consensus in future research of traumatic injury.
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Affiliation(s)
- Alexander Kumar
- Department of Surgery and Cancer, Pain Research Group, Imperial College, London, United Kingdom
- Academic Department of Military Anaesthesia, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Nadia Soliman
- Department of Surgery and Cancer, Pain Research Group, Imperial College, London, United Kingdom
| | - Zoe Gan
- Department of Surgery and Cancer, Pain Research Group, Imperial College, London, United Kingdom
| | - Paul Cullinan
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Jan Vollert
- Department of Surgery and Cancer, Pain Research Group, Imperial College, London, United Kingdom
| | - Andrew S.C. Rice
- Department of Surgery and Cancer, Pain Research Group, Imperial College, London, United Kingdom
| | - Harriet Kemp
- Department of Surgery and Cancer, Pain Research Group, Imperial College, London, United Kingdom
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2
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Long-term physical and psychological outcome following traumatic hemipelvectomy. Eur J Trauma Emerg Surg 2022; 49:1091-1100. [PMID: 36350350 PMCID: PMC10175454 DOI: 10.1007/s00068-022-02151-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/14/2022] [Indexed: 11/11/2022]
Abstract
Abstract
Purpose
First time examination of the physical and psychological long-term outcome following traumatic hemipelvectomy.
Methodology
In this study, all patients suffering from traumatic hemipelvectomy that were treated in a level-A trauma center since 1988 were retrospectively evaluated. The authors aimed to compare the physical and psychological outcome following primary amputation (A) vs. limb-preservation (LP) procedures. The patients were examined with a focus on pain, function, mobility and general health. As part of this examination, various scores were recorded, i.e., Majeed Score, Time up & Go or SF-36.
Results
The following work showed 13 patients who had suffered a traumatic hemipelvectomy, 8 of whom survived. Five of these were available for subsequent clinical re-examination; of these, three patients underwent an amputation, while limb preservation was performed on two patients. Mean follow-up of the amputee group was after 12 years compared to 6.5 years following limb preservation. After limb preservation, both patients reported phantom limb pain at the affected leg, despite pain medication. The general state of health was assessed as 82/100 (A) and 45/100 (LP). The Majeed score was 61 (A) vs. 45 (LP). In the clinical examination, three out of five patients (2 LP, 1 A) showed peroneal palsy (PP). In the quality-of-life analysis based on the SF12/36 and the NHP, amputees scored higher than the patients who underwent limb preservation surgery.
Conclusion
In our small patient cohort, satisfaction, pain and mobility tend to be better following primary amputation compared to limb preserving surgery.
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3
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Tye EY, Taylor AJ, Combs K, Kay RD, Bryman JA, Hoshino CM. Early Post-Traumatic Van Nes Rotationplasty After an Open Femur Fracture With a Necrotizing Soft-Tissue Infection: A Case Report. JBJS Case Connect 2021; 11:01709767-202112000-00039. [PMID: 34735381 DOI: 10.2106/jbjs.cc.21.00470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 26-year-old man presented after an automobile versus pedestrian accident with a Type IIIA open femur fracture complicated by a necrotizing soft-tissue infection (NSTI) with significant bone loss. Multiple limb-preserving operations failed, including the placement of a plate-assisted, motorized lengthening intramedullary nail with a chimeric free flap. We describe the patient's successful definitive treatment with a Van Nes rotationplasty (VNR). The patient currently ambulates independently with a prosthesis and is without recurrent infection after 3 years of follow-up. CONCLUSION VNR is a potential strategy to avoid transfemoral amputation or hip disarticulation in open femur fractures complicated by NSTI.
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Affiliation(s)
- Erik Y Tye
- Department of Orthopaedic Surgery, Harbor-University of California, Los Angeles, Medical Center, Torrance, California
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Ferguson M, Svendrovski A, Katz J. Pain Among an Inpatient Complex Chronic Care Population of Residents with and without Missing Limbs. J Pain Res 2021; 14:2921-2930. [PMID: 34552352 PMCID: PMC8450165 DOI: 10.2147/jpr.s319822] [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: 05/27/2021] [Accepted: 08/31/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose Limb loss occurs for various reasons (trauma, infection, vascular diseases, tumors, congenital absence). Limb loss is known to result in several types of pain. Little is known about pain in residents with missing limbs admitted to complex chronic care (CCC) facilities. This study examined the presence of pain and its intensity in CCC residents with and without missing limbs. Methods The Continuing Care Reporting System was accessed for data from residents admitted to Ontario com\plex chronic care facilities assessed with the Resident Assessment Instrument Minimum Data Set, V2.0. Propensity score matching (1:1 ratio) was used to identify a control resident without missing limbs for each case. McNemar’s test was used for dichotomous pain (Y/N) and Wilcoxon Signed Ranks test for ordinal pain (4-level and 7-level pain variables). Binary and multinomial logistic regression were used to quantify the relationship between missing limbs and reports of pain. Results Missing limbs were reported by 2961 residents (2.1%, original n=139,920) resulting in 2212 propensity matched pairs. A significantly higher proportion of missing limb cases had pain (80%) versus controls (70%), χ2=64.43, p<0.001. Significantly higher pain levels were found in cases versus controls (z=8.47, p<0.001 for 4-level pain; z=8.57, p<0.001 for 7-level pain). Residents with missing limbs were 1.46 (95% CI: 1.26–1.70) times more likely to report pain than controls, p<0.001. Conclusion The results point to the need to better manage pain in CCC residents with missing limbs.
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Affiliation(s)
- Meaghan Ferguson
- Faculty of Health, Department of Psychology, York University, Toronto, Ontario, Canada
| | | | - Joel Katz
- Faculty of Health, Department of Psychology, York University, Toronto, Ontario, Canada
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Khorram-Manesh A, Goniewicz K, Burkle FM, Robinson Y. Review of Military Casualties in Modern Conflicts-The Re-emergence of Casualties From Armored Warfare. Mil Med 2021; 187:e313-e321. [PMID: 33742659 PMCID: PMC8963150 DOI: 10.1093/milmed/usab108] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/08/2021] [Indexed: 11/12/2022] Open
Abstract
Introduction The re-emergence of armored warfare in modern conflicts has resulted in a higher number of extremity injuries, burns, and brain injuries. Despite this dramatic increase, little is reported on the type of injuries caused and their management. This review summarizes the publicly available literature and reports on the rate and type of injuries related to armored warfare, their medical outcomes, and management limitations. Materials and Methods This rapid evidence review involves a systematic literature search, followed by a non-systematic literature review. The reason for choosing this approach was the inherent lack of quantitative outcome data in the literature to satisfy the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The study also used content analysis to study all peer-reviewed articles, focusing on similarities and differences in the findings necessary to formulate tentative results. The electronic search included PubMed, Scopus, and Web of Science, using the following search string: “Armored; Injuries; Mechanized; Morbidity; Mortality; War; Warfare”, alone or in combination. Results Modern conflicts are associated with higher number of extremity injuries, burns, and brain injuries among military casualties. Several publications claim that the characteristics of armored warfare and anticipated injuries in this type of warfare might require the far forward deployment of medical support supported by a reliable casualty evacuation chain. Still the quality of the available casualty data is low. Conclusions Because of the limited availability of reliable data or military trauma registries, up-to-date military casualty estimation remains a recognized knowledge gap, which needs to be addressed by armed forces worldwide. The future management of modern war casualties requires professional and well-trained staff in all levels, indicating a need for educational initiatives to provide both nurses and medics a greater proportion of medical care and management capabilities and responsibilities than in past conflicts.
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Affiliation(s)
- Amir Khorram-Manesh
- Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg 413 45, Sweden
- Department of Development and Research, Armed Forces Center for Defense Medicine, Västra Frölunda 426 76, Sweden
| | - Krzysztof Goniewicz
- Department of Aviation Security, Military University of Aviation, Dęblin 08-521, Poland
| | - Frederick M Burkle
- Harvard Humanitarian Initiative, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Yohan Robinson
- Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg 413 45, Sweden
- Department of Development and Research, Armed Forces Center for Defense Medicine, Västra Frölunda 426 76, Sweden
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Oosterhoff M, Geertzen JHB, Dijkstra PU. More than half of persons with lower limb amputation suffer from chronic back pain or residual limb pain: a systematic review with meta-analysis. Disabil Rehabil 2020; 44:835-855. [PMID: 32603198 DOI: 10.1080/09638288.2020.1783377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: The aim of this study is to systematically review and critically assess the methodological quality of literature regarding prevalence, characteristics and factors influencing pain, other than phantom limb pain (PLP) in persons with lower limb amputation (LLA).Materials and methods: A systematic review was performed (PROSPERO CRD42019138018). Literature was searched using PubMed, EMBASE, PsycINFO, and PEDro. Studies were included if describing pain other than PLP at least three months after amputation. For residual limb pain (RLP) and back pain, a meta-regression was performed.Results: Fifty-one studies were included in which predominantly young males with a unilateral traumatic amputation using a prosthesis were investigated. Pooled prevalence of RLP was 0.51 (95% CI 0.40-0.62) with a positive association with presence of back pain (p = 0.044) in the univariate meta-regression. Pooled prevalence of back pain was 0.55 (95% CI 0.45-0.64), with a positive association of time since amputation (p < 0.001) and co-occurrence of RLP (p = 0.050).Conclusions: Back pain and RLP are common after LLA. The prevalence of back pain was positively associated with the presence of RLP, and vice versa. Future studies should give more attention to other chronic pain types, to persons with a diabetic or vascular cause of amputation, and to pain-related interference.Implications for RehabilitationBoth back pain and residual limb pain occur in more than 50% of persons with lower limb amputation (LLA), and both pain types are positively associated.Clinicians should be aware that chronic pain is common after LLA and can have a significant impact on the functioning of persons with LLA.Future research on this topic should give more attention to other chronic pain types, to persons with a diabetic or vascular cause of amputation, and to pain-related interference.
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Affiliation(s)
- Matthijs Oosterhoff
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan H B Geertzen
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pieter U Dijkstra
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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7
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Cahill SV, Yu KE, Dussik CM, Lee FY. Rotational Tibio-Pelvic Constrained Hip Arthroplasty: A Surgical Technique: A Case Report. JBJS Case Connect 2019; 9:e0404. [PMID: 31703012 DOI: 10.2106/jbjs.cc.18.00404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 25-year-old man presented with chronic bone and soft tissue infection of the right thigh following resection and radiation of epithelioid sarcoma. Multiple revisions and debridement procedures had failed to control the infection and left him unable to ambulate. We describe a modified Van Nes rotationplasty using a constrained, prosthetic hip between the tibia and pelvis following femur resection. With 18 months of follow-up, the patient was able to walk with a prosthetic device without evidence of recurrent infection. CONCLUSIONS We report this rotationplasty as a potential approach to avoid hip disarticulation in cases requiring extensive debridement for incurable infection.
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Affiliation(s)
- Sean V Cahill
- Department of Orthpaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut
| | - Kristin E Yu
- Department of Orthpaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut
| | - Christopher M Dussik
- Department of Orthpaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut
| | - Francis Y Lee
- Department of Orthpaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut
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8
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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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He Y, Qiu D, Zhou D, Li L, Wang B, Wang L. Treatment of Partial Traumatic Hemipelvectomy: A Study of 21 Cases. J Bone Joint Surg Am 2019; 101:e36. [PMID: 31045672 DOI: 10.2106/jbjs.18.00877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Partial traumatic hemipelvectomy (THP) is a catastrophic and life-threatening injury caused by high-energy impact. With advances in prehospital resuscitative techniques, more patients now survive this disastrous injury; however, the management of partial THP still lacks well-established therapeutic protocols. The purpose of this study was to present our experience in managing partial THP in a level-I trauma center. METHODS We retrospectively reviewed the medical records of 21 consecutive patients with partial THP. The key points of successful treatment are hemorrhage control, proper decision-making regarding amputation, treatment of associated injuries, and infection control. Data on patient demographics, injury characteristics, surgical management, and outcomes were recorded and analyzed. RESULTS Eight female and 13 male patients with a mean age of 31.3 years met the diagnostic criteria. The mean follow-up was 51.9 months. Of 17 surviving patients, 7 underwent primary amputation; limbs were successfully preserved in 4; and 6 patients underwent secondary amputation because of infection, organ dysfunction, and limb necrosis. Two patients died during resuscitation, and 2 patients died after amputation. Phantom limb pain, infection, and skin flap necrosis were the major postoperative complications. CONCLUSIONS THP requires cooperative multidisciplinary emergency diagnosis and treatment, early surgical intervention, and definitive treatment. Rapid resuscitation, adequate hemostasis, early amputation, and repeated debridement may improve survival. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Yu He
- Department of Orthopedic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, People's Republic of China.,Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Daodi Qiu
- Department of Orthopedic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, People's Republic of China
| | - Dongsheng Zhou
- Department of Orthopedic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, People's Republic of China
| | - Lianxin Li
- Department of Orthopedic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, People's Republic of China
| | - Bomin Wang
- Department of Orthopedic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, People's Republic of China
| | - Lubo Wang
- Department of Orthopedic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, People's Republic of China
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Faraji E, Allami M, Feizollahi N, Karimi A, Yavari A, Soroush M, Moudi M. Health concerns of veterans with high-level lower extremity amputations. Mil Med Res 2018; 5:36. [PMID: 30360763 PMCID: PMC6203280 DOI: 10.1186/s40779-018-0183-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 10/07/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The aim of the study was to identify health concerns of veterans with high-level lower extremity amputations. METHODS Through a cross-sectional study, general practitioners, an orthopedic specialist, psychologists, psychiatrists, physiotherapist and prosthetists examined 100 veterans using a short-form health-related quality of life questionnaire (SF-36) that assessed their ability to perform activities of daily living (ADL), instrumental activities of daily living (IADL) and life satisfaction (SWLS) after hip disarticulation or hemi-pelvectomy amputations. The assessment tool was designed to gather statistically useful information about their health needs. RESULTS The means of the Physical Component Summary (PCS), Mental Component Summary (MCS), SWLS, ADL and IADL were 48.58 ± 29.6, 33.33 ± 22.0, 19.30 ± 7.7, 48.10 ± 10.5 and 5.08 ± 1.8, respectively. Somatization, depression, and anxiety were the most prevalent disorders; among the veterans who were visited by psychiatrists, 11.6% had a history of hospitalization in a psychiatry section, and 53.2% had a psychiatric visit. Regardless of their injury in battle, 34% of veterans were hospitalized. Hearing problems were common, and about four-fifths of the participants suffered from at least one orthopedic condition. Neuroma (49%) was the most common stump-related complication during orthopedic evaluations, though the prevalence of phantom pain was 81% during the pain assessment. A total of 87% of the participants had a history of wearing a prosthesis, but only 29% wore a prosthesis at the time of the present study. The Canadian-type of prosthesis was uncomfortable and not useful (27%) and excessively heavy (10%) according to the amputees. CONCLUSIONS Understanding veterans' characteristics and special needs are important to make sure that enough facilities and services are afforded to them. These findings emphasize the importance of paying close attention to different dimensions of health in veterans and can help health providers identify health needs and make regular assessments.
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Affiliation(s)
- Elahe Faraji
- Janbazan Medical and Engineering Research Center (JMERC), NO.17, Farrokh St., Moghaddas Ardebily Ave., Chamran Highway, Tehran, Iran
| | - Mostafa Allami
- Janbazan Medical and Engineering Research Center (JMERC), NO.17, Farrokh St., Moghaddas Ardebily Ave., Chamran Highway, Tehran, Iran.
| | - Nafiseh Feizollahi
- Janbazan Medical and Engineering Research Center (JMERC), NO.17, Farrokh St., Moghaddas Ardebily Ave., Chamran Highway, Tehran, Iran
| | - Amir Karimi
- Janbazan Medical and Engineering Research Center (JMERC), NO.17, Farrokh St., Moghaddas Ardebily Ave., Chamran Highway, Tehran, Iran
| | - Amir Yavari
- Janbazan Medical and Engineering Research Center (JMERC), NO.17, Farrokh St., Moghaddas Ardebily Ave., Chamran Highway, Tehran, Iran
| | - Mohammadreza Soroush
- Janbazan Medical and Engineering Research Center (JMERC), NO.17, Farrokh St., Moghaddas Ardebily Ave., Chamran Highway, Tehran, Iran
| | - Majid Moudi
- Janbazan Medical and Engineering Research Center (JMERC), NO.17, Farrokh St., Moghaddas Ardebily Ave., Chamran Highway, Tehran, Iran
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Abstract
ABSTRACTThe impact of losing a limb in military service extends well beyond initial recovery and rehabilitation, with long-term consequences and challenges requiring health-care commitments across the lifecourse. This paper presents a systematic review of the current state of knowledge regarding the long-term impact of ageing and limb-loss in military veterans. Key databases were systematically searched including: ASSIA, CINAHL, Cochrane Library, Medline, Web of Science, PsycArticles/PsychInfo, ProQuest Psychology and ProQuest Sociology Journals, and SPORTSDiscus. Empirical studies which focused on the long-term impact of limb-loss and/or health-care requirements in veterans were included. The search process revealed 30 papers relevant for inclusion. These papers focused broadly on four themes: (a) long-term health outcomes, prosthetics use and quality of life; (b) long-term psycho-social adaptation and coping with limb-loss; (c) disability and identity; and (d) estimating the long-term costs of care and prosthetic provision. Findings present a compelling case for ensuring the long-term care needs and costs of rehabilitation for older limbless veterans are met. A dearth of information on the lived experience of limb-loss and the needs of veterans’ families calls for further research to address these important issues.
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12
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Moura DL, Garruço A. Hip disarticulation - case series analysis and literature review. Rev Bras Ortop 2017; 52:154-158. [PMID: 28409131 PMCID: PMC5380801 DOI: 10.1016/j.rboe.2016.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 09/01/2016] [Indexed: 11/29/2022] Open
Abstract
Objective To present a retrospective study of 16 patients submitted to hip disarticulation. Methods During the period of 16 years, 16 patients who underwent hip disarticulation were identified. All of them were studied based on clinical records regarding the gender, age at surgery, disarticulation cause, postoperative complications, mortality rates and functional status after hip disarticulation. Results Hip disarticulation was performed electively in most cases and urgently in only three cases. The indications had the following origins: infection (n = 6), tumor (n = 6), trauma (n = 3), and ischemia (n = 2). The mean post-surgery survival was 200.5 days. The survival rates were 6875% after six months, 5625% after one year, and 50% after three years. The mortality rates were higher in disarticulations with traumatic (66.7%) and tumoral (60%) causes. Regarding the eight patients who survived, half of them ambulate with crutches and without prosthesis, 25% walk with limb prosthesis, and 25% are bedridden. Complications and mortality were higher in the cases of urgent surgery, and in those with traumatic and tumoral causes. Conclusion Hip disarticulation is a major ablative surgery with obvious implications for limb functionality, as well as high rates of complications and mortality. However, when performed at the correct time and with proper indication, this procedure can be life-saving and can ensure the return to the home environment with a certain degree of quality of life.
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Affiliation(s)
- Diogo Lino Moura
- Centro Hospitalar e Universitário de Coimbra, Departamento de Ortopedia, Coimbra, Portugal
| | - António Garruço
- Centro Hospitalar e Universitário de Coimbra, Departamento de Ortopedia, Coimbra, Portugal
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13
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Moura DL, Garruço A. Desarticulação da anca – Análise de uma série e revisão da literatura. Rev Bras Ortop 2017. [DOI: 10.1016/j.rbo.2016.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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14
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Resnik L, Borgia M, Silver B. Measuring Community Integration in Persons With Limb Trauma and Amputation: A Systematic Review. Arch Phys Med Rehabil 2017; 98:561-580.e8. [DOI: 10.1016/j.apmr.2016.08.463] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/04/2016] [Accepted: 08/10/2016] [Indexed: 10/21/2022]
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15
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Christensen J, Ipsen T, Doherty P, Langberg H. Physical and social factors determining quality of life for veterans with lower-limb amputation(s): a systematic review. Disabil Rehabil 2016; 38:2345-53. [PMID: 26985705 DOI: 10.3109/09638288.2015.1129446] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Most veterans live for many years after their war-related traumatic lower-limb amputation, which is why understanding which factors influence health-related quality of life (HRQoL) remains important to their long-term management. The objective of this study was to perform a review of the literature to summarize any evidence on the physical and social determinants for HRQoL in veterans with uni- or bilateral lower-limb amputation(s). METHOD MEDLINE, EMBASE, PEDro, CINAHL, Scopus and Cochrane databases were searched systematically for eligible studies. Inclusion criteria were: traumatic lower-limb amputation(s), HRQoL outcome and veterans. Physical and social factors that influence HRQoL were extracted. RESULTS The literature search identified 2073 citations, leading to the inclusion of 10 studies in the systematic review. Physical activity level, sport participation, level of amputation, back pain, years of education, as well as duration and severity of phantom pain were found to be determining factors for HRQoL among veterans with lower-limb amputation. CONCLUSIONS The identified physical and social determinants were similar to those found in civilian traumatic amputees. More high quality research designs, interventions and complex statistical analyses are warranted to identify the physical and social factors that influence the HRQoL of veteran amputees. Implications for Rehabilitation Rehabilitation staff should promote physical activity and participation in sport among veterans with lower-limb amputation(s). Level of amputation, back pain severity, years of education, duration of phantom pain and severity of phantom pain have been found to be determining factors for HRQoL and should be taken into consideration when planning rehabilitation programs for veterans with lower-limb amputations.
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Affiliation(s)
- Jan Christensen
- a Department of Occupational and Physiotherapy Therapy , Copenhagen University Hospital , Copenhagen , Denmark ;,b CopenRehab, Section of Social Medicine, Department of Public Health, Faculty of Health , University of Copenhagen , Copenhagen , Denmark
| | - Thomas Ipsen
- b CopenRehab, Section of Social Medicine, Department of Public Health, Faculty of Health , University of Copenhagen , Copenhagen , Denmark
| | - Patrick Doherty
- c Department of Health Sciences , University of York , York , UK
| | - Henning Langberg
- a Department of Occupational and Physiotherapy Therapy , Copenhagen University Hospital , Copenhagen , Denmark
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Ebrahimzadeh MH, Moradi A, Bozorgnia S, Hallaj-Moghaddam M. Evaluation of disabilities and activities of daily living of war-related bilateral lower extremity amputees. Prosthet Orthot Int 2016; 40:51-7. [PMID: 25249384 DOI: 10.1177/0309364614547410] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 07/21/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Long-term consequences and the activities of daily living of bilateral lower limb amputation are not well documented. OBJECTIVES The aims of our study were to identify the long-term effects of bilateral lower extremity amputations on daily activities and understand how these amputees cope with their mobility assistive devices. STUDY DESIGN Cross-sectional study. METHODS A total of 291 veterans with war bilateral lower limb amputations accepted to participate in a cross-sectional study. RESULTS The average of follow-up was 25.4 years. A total of 152 amputees (54%) were involved in sports averagely 6.7 h per week. Bilateral amputees walk 10 m by the average of 15 ± 33 s, and they could walk continuously with their prosthesis 315 ± 295 m. They wore their prosthesis 6.8 ± 1.7 days per week and 7.9 ± 8.1 h per day. Of these, 6.7% of bilateral lower limb amputees needed help to wear their prosthesis; 88.3% of amputees used assistant device for walking. According to this survey, 73 (42%) prostheses in right limb were appropriate, 95 (54.6%) needed to be replaced, and 6 (3.4) needed to be fixed. On the left side, it was 76 (42%), 92 (52.0%), and 9 (5.1%), respectively. A total of 203 (74.9%) amputees reported limitations in at least one domain of the activities of daily living. The most common single item that affected the patients was ascending and descending stairs by the score of 66% of normal population. CONCLUSION Veterans with bilateral lower limb amputations suffering from vast categories of daily problems. CLINICAL RELEVANCE This study and its results confirm that bilateral lower limb amputees have major progressive disabilities in daily activities and their social performance. This should attract the attention of amputees' administrative organizations, social workers, health-care providers and caregiver providers.
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Affiliation(s)
| | - Ali Moradi
- Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Islamic Republic of Iran
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Datta R, Dhar M. Mirror therapy: An adjunct to conventional pharmacotherapy in phantom limb pain. J Anaesthesiol Clin Pharmacol 2015; 31:575-8. [PMID: 26702228 PMCID: PMC4676260 DOI: 10.4103/0970-9185.169102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Rashmi Datta
- Department of Anaesthesiology and Critical Care, Base Hospital, Delhi Cantonment, New Delhi, India
| | - Mridul Dhar
- Department of Anaesthesiology and Critical Care, Base Hospital, Delhi Cantonment, New Delhi, India
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Buttaro M, Freire J, Comba F, Zanotti G, Piccaluga F. Sauerbruch-van Nes total turn-up plasty for infected total hip arthroplasty - a case report. Acta Orthop 2015; 86:270-1. [PMID: 25340547 PMCID: PMC4404783 DOI: 10.3109/17453674.2014.978701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Martin Buttaro
- Hip Surgery Unit, the Carlos E. Ottolenghi Institute of Orthopaedics, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - José Freire
- Hip Surgery Unit, the Carlos E. Ottolenghi Institute of Orthopaedics, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Fernando Comba
- Hip Surgery Unit, the Carlos E. Ottolenghi Institute of Orthopaedics, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Gerardo Zanotti
- Hip Surgery Unit, the Carlos E. Ottolenghi Institute of Orthopaedics, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Francisco Piccaluga
- Hip Surgery Unit, the Carlos E. Ottolenghi Institute of Orthopaedics, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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Bhatnagar V, Richard E, Melcer T, Walker J, Galarneau M. Lower-limb amputation and effect of posttraumatic stress disorder on Department of Veterans Affairs outpatient cost trends. ACTA ACUST UNITED AC 2015; 52:827-38. [DOI: 10.1682/jrrd.2014.11.0288] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 07/01/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Vibha Bhatnagar
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA; and Department of Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Erin Richard
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA; and Department of Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Ted Melcer
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA
| | - Jay Walker
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA
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Validity and cross-cultural adaptation of the persian version of the oxford elbow score. Int J Rheumatol 2014; 2014:381237. [PMID: 25214845 PMCID: PMC4158467 DOI: 10.1155/2014/381237] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 07/28/2014] [Indexed: 11/22/2022] Open
Abstract
Oxford Elbow Score (OES) is a patient-reported questionnaire used to assess outcomes after elbow surgery. The aim of this study was to validate and adapt the OES into Persian language. After forward-backward translation of the OES into Persian, a total number of 92 patients after elbow surgeries completed the Persian OES along with the Persian DASH and SF-36. To assess test-retest reliability, 31 randomly selected patients (34%) completed the Persian OES again after three days while abstaining from all forms of therapeutic regimens. Reliability of the Persian OES was assessed by measuring intraclass correlation coefficient (ICC) for test-retest reliability and Cronbach's alpha for internal consistency. Spearman's correlation coefficient was used to test the construct validity. Cronbach's alpha coefficient was 0.92 showing excellent reliability. Cronbach's alpha for function, pain, and social-psychological subscales was 0.95, 0.86, and 0.85, respectively. Intraclass correlation coefficient (ICC) was 0.85 for the overall questionnaire and 0.90, 0.76, and 0.75 for function, pain, and social-psychological subscales, respectively. Construct validity was confirmed as the Spearman correlation between OES and DASH was 0.80. Persian OES is a valid and reliable patient-reported outcome measure to assess postsurgical elbow status in Persian speaking population.
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Kachooei AR, Ebrahimzadeh MH, Hallaj Moghadam M, Fattahi AS, Razi S, Salehi M, Azema H. Disabilities and activities of daily living among veterans with old hip disarticulation and transpelvic amputation. ARCHIVES OF TRAUMA RESEARCH 2014; 3:e16003. [PMID: 25032170 PMCID: PMC4080485 DOI: 10.5812/atr.16003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 02/03/2014] [Accepted: 03/01/2014] [Indexed: 11/20/2022]
Abstract
Background: The Iran-Iraq imposed war lasted eight years and was one of the longest wars of the last century. Twenty-three years have passed since the war ended, but little has been discussed about the long-term results of war amputations in the literature. Objectives: In this long-term study, we have evaluated the activities of daily living among veterans with hip or hemipelvis amputations. Patients and Methods: A cross-sectional study was performed on Iran-Iraq war veterans with hip or hemipelvis amputations in Iran. Eighty-four (96.5%) veterans out of 87 registered veterans with hip or hemipelvis amputations participated in the study. The degree of independence for activities of daily living (ADL) was assessed by the Barthel index. The degree of independence for instrumental activities of daily living (IADL) was assessed by the Lawton-Brody scale. Results: The average follow-up time was 26.6 ± 3.7 years. The average age of veterans was 44.1±7 years old. Of 84 amputees, 57 (67.85%) had limitations in at least one domain of the ADL. The most common single item that affected the patients was ascending and descending stairs seen in 45 (78.9%) veterans, followed by eating seen in 4 (7.01%) veterans. In addition, 70 (83.33%) had limitations in at least one domain of the IADL. The most common single item that affected the veterans was shopping seen in 56 (80%), followed by responsibility for own medications seen in 13 (18.57%) veterans. Spearman correlation coefficient of the sum scores of ADL and IADL showed an intermediate to strong correlation (r = 0.58). Conclusions: Increasing dependency in ADL is accompanied by increasing dependency in IADL. In the past, the duty of health care providers was saving the life of veterans due to injuries while at present, because these injuries occurred in young and healthy individuals, the need for increased function is being highlighted.
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Affiliation(s)
- Amir Reza Kachooei
- Department of Orthopedic Surgery, Orthopedic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mohamad Hosein Ebrahimzadeh
- Department of Orthopedic Surgery, Orthopedic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding author: Mohamad Hosein Ebrahimzadeh, Department of Orthopedic Surgery, Orthopedic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran. P. O. Box: 91799-9199, Tel/Fax: +98-5118417453, E-mail:
| | - Mohamad Hallaj Moghadam
- Department of Orthopedic Surgery, Orthopedic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Asieh-sadat Fattahi
- Endoscopic and Minimally Invasive Surgery Research Center, Department of Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Shiva Razi
- Department of Orthopedic Surgery, Orthopedic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Maryam Salehi
- Community Medicine Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Hasan Azema
- Janbazan Medical and Engineering Research Center, Tehran, IR Iran
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