TY - JOUR
T1 - The Military Extremity Trauma Amputation/Limb Salvage (METALS) Study
T2 - Outcomes of Amputation Compared with Limb Salvage Following Major Upper-Extremity Trauma
AU - Mitchell, Stuart L.
AU - Hayda, Roman
AU - Chen, Andrew T.
AU - Carlini, Anthony R.
AU - Ficke, James R.
AU - Mackenzie, Ellen J.
N1 - Funding Information:
This study was funded in part by a grant from the U.S. Department of Defense, Military Amputee Research Program of the United States Army Medical Research Acquisition Activity (USAMRAA) (Contract Number: W81XWH-06-1-0361), and by a grant from the National Institutes of Health (T32 AR067708).
Publisher Copyright:
© 2019 by the Journal of Bone and Joint Surgery, Incorporated.
PY - 2019/8/21
Y1 - 2019/8/21
N2 - Background:Severe upper-extremity injuries account for almost one-half of all extremity trauma in recent conflicts in the Global War on Terror. Few long-term outcomes studies address severe combat-related upper-extremity injuries. This study's objective was to describe long-term functional outcomes of amputation compared with those of limb salvage in Global War on Terror veterans who sustained severe upper-extremity injuries. Limb salvage was hypothesized to result in better arm and hand function scores, overall functional status, and quality of life, with similar pain interference.Methods:This retrospective cohort study utilized data from the Military Extremity Trauma Amputation/Limb Salvage (METALS) study for a subset of 155 individuals who sustained major upper-extremity injuries treated with amputation or limb salvage. Participants were interviewed by telephone 40 months after injury, assessing social support, personal habits, and patient-reported outcome instruments for function, activity, depression, pain, and posttraumatic stress. Outcomes were evaluated for participants with severe upper-extremity injuries and were compared with participants with concomitant severe, lower-extremity injury. The analysis of outcomes comparing limb salvage with amputation was restricted to the 137 participants with a unilateral upper-extremity injury because of the small number of patients with bilateral upper-extremity injuries (n = 18).Results:Overall, participants with upper-extremity injuries reported moderate to high levels of physical and psychosocial disability. Short Musculoskeletal Function Assessment (SMFA) scores were high across domains; 19.4% screened positive for posttraumatic stress disorder (PTSD), and 12.3% were positive for depression. Nonetheless, 63.6% of participants were working, were on active duty, or were attending school, and 38.7% of participants were involved in vigorous recreational activities. No significant differences in outcomes were observed between patients who underwent limb salvage and those who underwent amputation.Conclusions:Severe, combat-related upper-extremity injuries result in diminished self-reported function and psychosocial health. Our results suggest that long-term outcomes are equivalent for those treated with amputation or limb salvage. Addressing or preventing PTSD, depression, chronic pain, and associated health habits may result in less disability burden in this population.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence..
AB - Background:Severe upper-extremity injuries account for almost one-half of all extremity trauma in recent conflicts in the Global War on Terror. Few long-term outcomes studies address severe combat-related upper-extremity injuries. This study's objective was to describe long-term functional outcomes of amputation compared with those of limb salvage in Global War on Terror veterans who sustained severe upper-extremity injuries. Limb salvage was hypothesized to result in better arm and hand function scores, overall functional status, and quality of life, with similar pain interference.Methods:This retrospective cohort study utilized data from the Military Extremity Trauma Amputation/Limb Salvage (METALS) study for a subset of 155 individuals who sustained major upper-extremity injuries treated with amputation or limb salvage. Participants were interviewed by telephone 40 months after injury, assessing social support, personal habits, and patient-reported outcome instruments for function, activity, depression, pain, and posttraumatic stress. Outcomes were evaluated for participants with severe upper-extremity injuries and were compared with participants with concomitant severe, lower-extremity injury. The analysis of outcomes comparing limb salvage with amputation was restricted to the 137 participants with a unilateral upper-extremity injury because of the small number of patients with bilateral upper-extremity injuries (n = 18).Results:Overall, participants with upper-extremity injuries reported moderate to high levels of physical and psychosocial disability. Short Musculoskeletal Function Assessment (SMFA) scores were high across domains; 19.4% screened positive for posttraumatic stress disorder (PTSD), and 12.3% were positive for depression. Nonetheless, 63.6% of participants were working, were on active duty, or were attending school, and 38.7% of participants were involved in vigorous recreational activities. No significant differences in outcomes were observed between patients who underwent limb salvage and those who underwent amputation.Conclusions:Severe, combat-related upper-extremity injuries result in diminished self-reported function and psychosocial health. Our results suggest that long-term outcomes are equivalent for those treated with amputation or limb salvage. Addressing or preventing PTSD, depression, chronic pain, and associated health habits may result in less disability burden in this population.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence..
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U2 - 10.2106/JBJS.18.00970
DO - 10.2106/JBJS.18.00970
M3 - Article
C2 - 31436655
AN - SCOPUS:85071522995
SN - 0021-9355
VL - 101
SP - 1470
EP - 1478
JO - Journal of Bone and Joint Surgery - American Volume
JF - Journal of Bone and Joint Surgery - American Volume
IS - 16
ER -