Common factors and outcome in late upper extremity amputations after military injury

OBJECTIVES:: Much attention has been given to lower extremity amputations that occur more than 90 days after injury, but little focus has been given to analogous upper extremity amputations. The purpose of this study was to determine the reason(s) for desired amputation and the common complications after amputation for those combat-wounded service members who underwent late upper extremity amputation. DESIGN:: Retrospective case series. SETTING:: Tertiary trauma center. PATIENTS/PARTICIPANTS:: All US service members who sustained major extremity amputations from September 2001 to July 2011 were analyzed. INTERVENTION:: Late (>90 days after injury) upper extremity amputations. MAIN OUTCOME MEASUREMENTS:: Amputation level(s), time to amputation, age, number of operations, pre/postoperative complications, reason(s) for desiring amputation, and disability outcomes were analyzed. RESULTS:: Seven of 218 (3.2%) upper extremity amputees had a late upper extremity amputation (>90 days from injury to amputation). The mean and median number of days from injury to amputation was 689 and 678, respectively. The most common preamputation complications were loss of wrist or finger motion (7, 100%), neurogenic pain (4, 57%), and heterotopic ossification (4, 57%). Three (43%) patients (2 persistent and 1 new onset) had neurogenic pain and 2 (29%) had heterotopic ossification after amputation. Only 57% (4 of 7) of amputees used their prostheses regularly. CONCLUSIONS:: Service members undergoing late upper extremity amputation seem to have different pre- and postoperative complications than those patients undergoing late lower extremity amputations. It was common for the amputee to not wear their prostheses and to experience similar complications after amputation, albeit in a less severe form.