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2014 ; 472
(10
): 3010-6
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Bilateral transfemoral/transtibial amputations due to battle injuries: a
comparison of Vietnam veterans with Iraq and Afghanistan servicemembers
#MMPMID24585323
Dougherty PJ
; McFarland LV
; Smith DG
; Reiber GE
Clin Orthop Relat Res
2014[Oct]; 472
(10
): 3010-6
PMID24585323
show ga
BACKGROUND: Multiple limb loss from combat injuries has increased as a proportion
of all combat-wounded amputees. Bilateral lower-extremity limb loss is the most
common, with bilateral transfemoral amputations being the most common subgroup
followed by bilateral amputations consisting of a single transfemoral amputation
and a single transtibial amputation (TFTT). With improvements in rehabilitation
and prostheses, we believe it is important to ascertain how TFTT amputees from
the present conflicts compare to those from the Vietnam War. QUESTIONS/PURPOSES:
We compared self-reported (1) health status, (2) quality of life (QoL), (3)
prosthetic use, and (4) function level between TFTT amputees from the Vietnam War
and Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF). METHODS: As
part of a larger survey, during 2007 to 2008, servicemembers with a diagnosis of
amputation associated with battlefield injuries from the Vietnam War and OIF/OEF
were identified from the Veterans Affairs and military databases. Participants
were asked to respond to a questionnaire to determine their injuries, surgical
history, presence of other medical problems, health status, QoL, function, and
prosthetic use. We assessed QoL and health status using single-item questions and
function using seven categories of physical activity. Thirteen of 298 (4.3%)
participants in the Vietnam War group and 11 of 283 (3.8%) in the OIF/OEF group
had sustained TFTT amputations. Mean age ± SD at followup was 61 ± 2 years and 28
± 5 years for the Vietnam War and OIF/OEF groups, respectively. RESULTS:
Excellent, very good, and good self-reported health (85% versus 82%; p = 0.85)
and QoL (69% versus 72%; p = 0.85) were similar between the Vietnam War and
OIF/OEF groups, respectively. Level of function was higher in the OIF/OEF group,
with four of 11 reporting participation in high-impact activities compared to
none in the Vietnam War group (p = 0.018). CONCLUSIONS: Participants with TFTT
limb loss from both conflicts reported similar scores for QoL and health status,
although those from OIF/OEF reported better function and use of prosthetic
devices. It is unclear whether the improved function is from age-related changes
or improvements in rehabilitation and prosthetics. Some areas of future research
might include longitudinal studies of those with limb loss and assessments of
physical function of older individuals with limb loss as the demographics shift
to where this group of individuals becomes more prominent.
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