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The Journal of Sports Medicine and... Aug 2014Amputation in athletes has a substantial impact on lifestyle and sporting activity, as well as self-perception and quality of life. The impact of limb loss on athletic... (Review)
Review
Amputation in athletes has a substantial impact on lifestyle and sporting activity, as well as self-perception and quality of life. The impact of limb loss on athletic ability will vary depending on the cause of amputation and the anatomical location of the amputation. The use of sporting activity for rehabilitation of amputees was first introduced in 1944 at Stoke Mandeville Hospital. The first international paralympic games were founded in 1960. Following these events the opportunity to participate in sport following limb loss has increased significantly. Sport participation has been aided by the development of sporting prostheses, however multiple factors will determine the exact prosthesis used. These include the nature of the sporting activity as well as the level of the amputation. The biomechanics involved in walking and running are altered following the loss of a limb or part thereof. This can cause subsequent degenerative changes within the remaining joints on the amputated limb as well as the contralateral limb. Factors affecting return to sporting activity are multivariate and inter-related, including patient factors, surgical factors, nature and level of the sporting activity and prosthetic factors. The authors review current literature, detail predictive factors of return to sport and the physical and psychosocial impact on patients following limb amputation.
Topics: Amputation, Surgical; Amputees; Artificial Limbs; Biomechanical Phenomena; Humans; Lower Extremity; Osteoarthritis; Quality of Life; Running; Sports; Upper Extremity; Walking
PubMed: 25034549
DOI: No ID Found -
Injury Dec 2011Lower limb amputation (LLA) is life-changing surgery. Shorter residual limbs are known to place greater physiological strain on patients than longer residual limbs;... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Lower limb amputation (LLA) is life-changing surgery. Shorter residual limbs are known to place greater physiological strain on patients than longer residual limbs; however, there is ongoing debate as to whether through-knee amputations are preferable to above-knee amputations. This analysis aims to resolve this question by systematically collecting and pooling published and unpublished data on this subject.
METHODS
An exhaustive search of Medline, Embase and Recal databases was made for outcome studies of patients with lower limb amputations following trauma. Studies concerned with amputations of the upper limb or foot and ankle were excluded as were papers reporting outcomes in a population of mixed trauma and non-trauma patients. Authors of studies published in the last 10 years were contacted for unpublished details. Patients were then divided, according to amputation height, into four groups: below-knee amputation (BKA), through-knee amputation (TKA), above-knee amputation (AKA) and bilateral amputation. The primary outcome measure was Physical Component Score (PCS) of the short-form-36 measure of quality of life and secondary outcomes were pain, employment, ability to walk 500m and proportion of time that prosthesis is worn.
RESULTS
As many as 27 studies were included, representing a total of 3105 patients, 1855 with a BKA, 104 with a TKA, 888 with an AKA and 258 bilateral amputees. There was progressive and significant lowering of PCS (worsening outcomes) as unilateral amputation height became more proximal from BKA to TKA and AKA. A significantly greater proportion of patients with a BKA or a TKA were able to walk 500m than those with an AKA or bilateral amputation (p=0.0035). However, patients with a TKA wore their prosthesis significantly less, and had significantly more pain than those with an AKA.
CONCLUSION
This study describes the impact of LLA of different levels on patients' lives. The results indicate that patients with a TKA have a better physical quality of life than those with an AKA and, therefore, support the surgical strategy of maintaining maximum length and performing TKA in preference to AKA, where possible.
Topics: Amputation, Surgical; Amputation Stumps; Artificial Limbs; Databases, Bibliographic; Employment; Humans; Knee Joint; Leg; Leg Injuries; Lower Extremity; Military Personnel; Outcome Assessment, Health Care; Pain; Quality of Life; Walking
PubMed: 21831371
DOI: 10.1016/j.injury.2011.07.005 -
International Orthopaedics Feb 2019To highlight the most important innovations and milestones in the historical evolution of amputation and disarticulation surgery through the ages, from the early... (Review)
Review
PURPOSE
To highlight the most important innovations and milestones in the historical evolution of amputation and disarticulation surgery through the ages, from the early antiquity until the modern era.
METHOD
A thorough search of the literature was undertaken in PubMed and Google Scholar as well as in physical books in libraries to summarize current and classic literature on the hallmarks of the history of amputation surgery in the course of medical history.
RESULTS
Amputation of a limb is one of the oldest surgical procedures. Initially, it was fraught with complications and dismal outcome of the patients because of hemorrhage and infection. Due to lack of analgesics and narcotics the operation had to take only a few minutes. Obtaining experience, the surgeons evolved the operative technique and refined the procedure, anesthesia and perioperative analgesia was introduced, instruments were developed, and rehabilitation has enabled functional and social reintegration of amputees.
CONCLUSION
From the Hippocratic era until currently, the surgical approach to amputation has changed little. However, the indications for amputations have changed a lot and had been refined, especially in diabetic patients and in those with severe chronic peripheral vascular disease. An exponential decrease in mortality for an operation once fraught with complications was due to the development of the tourniquet, proper vessel ligation and repair, antisepsis, and anesthesia.
Topics: Amputation, Surgical; Anesthesia; Extremities; History, 15th Century; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; History, Ancient; History, Medieval; Humans; Infection Control; Internationality; Replantation
PubMed: 29948012
DOI: 10.1007/s00264-018-4024-6 -
Vascular Dec 2022Through-knee amputation is an umbrella term for several different surgical techniques, which may affect clinical and functional outcomes. This makes it hard to evaluate... (Review)
Review
OBJECTIVES
Through-knee amputation is an umbrella term for several different surgical techniques, which may affect clinical and functional outcomes. This makes it hard to evaluate the benefits and need for a through-knee amputation approach. This article seeks to (1) determine the number of through-knee amputation performed compared with other major lower limb amputations in England over the past decade; (2) identify the theoretical concepts behind through-knee amputation surgical approaches and their potential effect on functional and clinical outcomes and (3) provide a platform for discussion and research on through-knee amputation and surgical outcomes.
METHODS
National Health Service Hospital Episodes Statistics were used to obtain recent numbers of major lower limb amputations in England. EMBASE and MEDLINE were searched using a systematic approach with predefined criteria for relevant literature on through-knee amputation surgery.
RESULTS
In the past decade, 4.6% of major lower limb amputations in England were through-knee amputations. Twenty-six articles presenting through-knee amputation surgical techniques met our criteria. These articles detailed three through-knee amputation surgical techniques: the classical approach, which keeps the femur intact and retains the patella; the Mazet technique, which shaves the femoral condyles into a box shape and the Gritti-Stokes technique, which divides the femur proximal to the level of the condyles and attaches the patella at the distal cut femur.
CONCLUSIONS
Through-knee amputation has persisted as a surgical approach over the past decade, with three core approaches identified. Studies reporting clinical, functional and biomechanical outcomes of through-knee amputation frequently fail to distinguish between the three distinct and differing approaches, making direct comparisons difficult. Future studies that compare through-knee amputation approaches to one another and to other amputation levels are needed.
Topics: Humans; State Medicine; Disarticulation; Amputation, Surgical; Lower Extremity; England
PubMed: 34844469
DOI: 10.1177/17085381211045183 -
Clinical Orthopaedics and Related... Oct 2014Limb amputation has been carried out through the ages as a punitive method in various parts of the world. This article highlights the historical and societal background... (Review)
Review
BACKGROUND
Limb amputation has been carried out through the ages as a punitive method in various parts of the world. This article highlights the historical and societal background associated with the use of punitive limb amputation.
METHODS
We performed an extensive electronic search of the pertinent literature augmented with a hand-search of additional sources.
RESULTS
Evidence for punitive amputation is available as early as the court of the Babylonian Code of King Hammurabi (circa 1750 Before the Common Era [BCE]), which imposed punitive limb amputations on slaves who used force against free citizens. Other reports provided evidence that punitive amputation was used as early as the 4th century BCE in ancient Peru. Limb amputation restored law and order during the Roman and Byzantine periods. Amputation as a punitive instrument prevailed in Europe throughout the 17th century. During the Enlightenment, the intellectual movement in Europe approached criminal law from a humanistic perspective, incorporated it into societal practice, and promoted its preventive dimensions. Punitive limb amputation still exists in several Arab and African countries.
CONCLUSION
Amputation as a punitive or correctional method has its roots in old civilizations. It has been used through the ages in various parts of the world. While it has been abandoned in modern western societies, punitive amputation is still used in several third-world countries.
Topics: Amputation, Surgical; Crime; Developing Countries; History, 17th Century; History, Ancient; Humans; Punishment; Sculpture; Social Control, Formal; Social Perception
PubMed: 24522383
DOI: 10.1007/s11999-014-3480-6 -
Nursing Standard (Royal College of...The decision to amputate is a difficult one, but in some cases, amputation can greatly improve the patient's quality of life. Jo Gibson discusses the nursing care of... (Review)
Review
The decision to amputate is a difficult one, but in some cases, amputation can greatly improve the patient's quality of life. Jo Gibson discusses the nursing care of patients undergoing amputation, with a view to helping them adjust to their changed circumstances.
Topics: Adaptation, Psychological; Amputation, Surgical; Decision Making; Humans; Leg; Needs Assessment; Nurse's Role; Patient Education as Topic; Patient Selection; Perioperative Care; Quality of Life; Recovery of Function; Wound Healing
PubMed: 12216256
DOI: 10.7748/ns2001.03.15.28.47.c3002 -
Physical Medicine and Rehabilitation... Feb 2019Traumatic amputation can result from injuries sustained both within and outside the military setting. Individuals with trauma-related amputations have unique needs and... (Review)
Review
Traumatic amputation can result from injuries sustained both within and outside the military setting. Individuals with trauma-related amputations have unique needs and require specialized management with an interdisciplinary team approach and care coordination across the continuum of care to facilitate optimal outcomes. Management considerations include issues with the amputation itself, issues related to injury of other body parts, and the management of longer-term secondary conditions. Some of these issues are more prevalent and of greater severity in the early recovery period, whereas others develop later and have the potential for progressive worsening over time.
Topics: Amputation, Surgical; Amputation, Traumatic; Amputees; Artificial Limbs; Humans; Leg Injuries; Lower Extremity; Military Personnel; United States; United States Department of Veterans Affairs; Veterans
PubMed: 30470431
DOI: 10.1016/j.pmr.2018.08.008 -
Physical Medicine and Rehabilitation... Feb 2014Most people with amputations should not experience pain that interferes with their quality of life or requires regular medication more than 6 months following the... (Review)
Review
Most people with amputations should not experience pain that interferes with their quality of life or requires regular medication more than 6 months following the amputation surgery. In fact, most people with amputations do not experience significant pain more than 3 months following the amputation. However, the clinician must specifically define what these patients mean when they relate that they have pain. The pain must be carefully differentiated to treat it properly. Most problematic pain that is present more than 6 months after amputation is related to a poorly fitting prosthesis and should be labeled as residual limb pain.
Topics: Algorithms; Amputation, Surgical; Amputation Stumps; Artificial Limbs; Humans; Phantom Limb; Prosthesis Fitting
PubMed: 24287239
DOI: 10.1016/j.pmr.2013.09.008 -
The American Journal of Emergency... Jul 2020Prehospital limb amputation is a rare but potentially life-saving intervention. When patients cannot be extricated due to limb entrapment or have hemodynamic compromise...
OBJECTIVE
Prehospital limb amputation is a rare but potentially life-saving intervention. When patients cannot be extricated due to limb entrapment or have hemodynamic compromise that precludes a prolonged extrication, they may benefit from an emergent prehospital amputation. The objective was to experimentally compare three prehospital amputation techniques on porcine legs.
METHODS
The three techniques studied were a scalpel with a Gigli saw, a hacksaw, and a reciprocating saw. For the first technique, a scalpel was used to make a circumferential incision in the soft tissue and a Gigli wire saw to cut through the bone. The second and third techniques only used a saw and did not require soft tissue incision with a scalpel. Three providers including an emergency medicine physician, a paramedic, and a medical student performed three amputations of each technique, resulting in twenty-seven total amputations. The primary outcome was amputation time. Secondary outcomes were rate of instrument malfunction and cleanliness of cut.
RESULTS
The primary outcome of amputation time was different between techniques. The Gigli saw technique took 32.86 ± 16.53 s (mean ± SD), hacksaw technique 6.28 ± 0.76 s, and reciprocating saw technique 2.84 ± 0.40 s. There were no differences in amputation time between participants for a given amputation technique. The Gigli saw technique had an instrument malfunction on 3/9 trials which was distinct from the other techniques. Differences in cleanliness of cut were nonsignificant.
CONCLUSIONS
Prehospital limb amputation with a hacksaw or reciprocating saw may result in faster completion of the time-sensitive procedure with fewer instrument malfunctions.
Topics: Amputation, Surgical; Animals; Emergency Medical Services; Emergency Medical Technicians; Emergency Medicine; Hindlimb; Operative Time; Physicians; Students, Medical; Surgical Instruments; Swine
PubMed: 31831349
DOI: 10.1016/j.ajem.2019.09.002 -
The Journal of Foot and Ankle Surgery :... 2016Transmetatarsal amputations have generally been accepted as a relatively more definitive amputation compared with other lesser ray resections. However, many... (Meta-Analysis)
Meta-Analysis Review
Transmetatarsal amputations have generally been accepted as a relatively more definitive amputation compared with other lesser ray resections. However, many investigators have reported a high occurrence of more proximal amputation after transmetatarsal amputation. A systematic review was performed to evaluate the occurrence of reamputation and reoperation after transmetatarsal amputations. A search of the Medline, CINAHL, and Cochrane Central databases yielded 159 abstracts. After review, 24 reports were included in the study. A total of 391 (26.9%) reoperations were identified after 1453 transmetatarsal amputations. Any level reamputation occurred in 152 (29.7%) of 365 transmetatarsal amputations and major amputation occurred in 380 (33.2%) of 1146 transmetatarsal amputations. Using a random effects model, the reoperation rate was estimated at 24.43% (95% confidence interval 11.64% to 37.21%), the reamputation rate was estimated at 28.37% (95% confidence interval 19.56% to 37.19%), and the major amputation rate was estimated at 30.16% (95% confidence interval 23.86% to 36.47%). These findings raise questions about the conventional wisdom of performing primary transmetatarsal amputation in lieu of other minor amputations, such as partial first ray amputation, and suggest that the choice between transmetatarsal amputation and other minor amputations might be a decision that depends on very patient-specific factors.
Topics: Aged; Amputation, Surgical; Diabetic Foot; Female; Humans; Male; Metatarsal Bones; Middle Aged; Prognosis; Reoperation; Risk Assessment; Severity of Illness Index; Wound Healing
PubMed: 27475711
DOI: 10.1053/j.jfas.2016.05.011