Blast-induced lower extremity fractures with arterial injury: Prevalence and risk factors for amputation after initial limb-preserving treatment

David E. Gwinn, Scott M. Tintle, Anand R. Kumar, Romney C. Andersen, John J. Keeling

Research output: Contribution to journalArticle

Abstract

Objectives: The purpose of this study is to determine the rate of late (secondary) amputation and to identify risk factors for amputation in injuries that were initially treated with limb preservation on the battlefield. Methods: A retrospective review at our institution identified 24 consecutive patients with 26 blast-induced open fractures distal to the joint that had associated arterial injuries. All injuries were initially cared for on the battlefield and during the evacuation chain of care with limb preservation protocols. All definitive orthopaedic care was provided by a single fellowship-trained orthopaedic trauma surgeon at a tertiary care stateside facility. Injury factors were analyzed based on radiographic and chart review to determine associations with amputation. Results: Twenty of 26 injured limbs received an amputation for a total amputation rate of 76.9% (95% confidence interval, 57.9-88.9%). Fourteen limbs received early amputation before limb salvage attempts. Six of the 12 limbs that received limb salvage underwent late amputation. Conclusions: The rate of amputation in severe blast-induced extremity fractures combined with an arterial injury initially treated with limb preservation on the battlefield and before transfer to the definitive military treatment facility is extremely high. Blast-injured lower limbs with a combined severe bony and soft tissue injury should be carefully assessed when arterial injury is present because they may require early amputation during initial surgical care on the battlefield.

Original languageEnglish (US)
Pages (from-to)543-548
Number of pages6
JournalJournal of Orthopaedic Trauma
Volume25
Issue number9
DOIs
StatePublished - Sep 2011
Externally publishedYes

Fingerprint

Amputation
Lower Extremity
Extremities
Wounds and Injuries
Limb Salvage
Therapeutics
Military Facilities
Soft Tissue Injuries
Open Fractures
Tertiary Healthcare
Orthopedics
Joints
Confidence Intervals

Keywords

  • amputation
  • arterial injury
  • blast trauma
  • limb salvage
  • wartime injury

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Blast-induced lower extremity fractures with arterial injury : Prevalence and risk factors for amputation after initial limb-preserving treatment. / Gwinn, David E.; Tintle, Scott M.; Kumar, Anand R.; Andersen, Romney C.; Keeling, John J.

In: Journal of Orthopaedic Trauma, Vol. 25, No. 9, 09.2011, p. 543-548.

Research output: Contribution to journalArticle

Gwinn, David E. ; Tintle, Scott M. ; Kumar, Anand R. ; Andersen, Romney C. ; Keeling, John J. / Blast-induced lower extremity fractures with arterial injury : Prevalence and risk factors for amputation after initial limb-preserving treatment. In: Journal of Orthopaedic Trauma. 2011 ; Vol. 25, No. 9. pp. 543-548.
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