Major replantation versus revision amputation and prosthetic fitting in the upper extremity: a late functional outcomes study.
The functional outcomes of amputated arms that were either replanted or had a prosthesis were compared. In addition, factors that influenced the functional outcome of replants were evaluated. The Carroll test was used to evaluate functional capacity of 22 successful upper extremity replantations at or proximal to the wrist as well as 22 amputees (at similar levels) fitted with a variety of prosthetic devices. The outcome was excellent or good in 8 (36%) replanted limbs. This proportion was statistically higher than those grades in the prosthetic group. When the groups were more closely matched (adults with below elbow injuries), the replantation group had 6 (50%) good or excellent outcomes and the prosthetic group had none. An analysis of covariance of the replantations demonstrated a statistical association between a better outcome in younger patients with more distal injuries. This study indicates that replantation produces superior functional results compared with amputation and a prosthesis.
Division of Orthopaedic Surgery, University of Toronto, Ontario.
B
B
Graham
P
P
Adkins
T M
TM
Tsai
J
J
Firrell
W C
WC
Breidenbach
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000671:Amputation, Surgical / Q000379:methods / Q000534:rehabilitation*; D000704:Analysis of Variance; D001132:Arm / Q000601:surgery*; D001134:Arm Injuries / Q000601:surgery*; D001186:Artificial Limbs; D002648:Child; D002675:Child, Preschool; D005260:Female; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011379:Prognosis; D017755:Prosthesis Fitting / Q000379:methods; D016059:Range of Motion, Articular; D012092:Replantation / Q000379:methods*; D016896:Treatment Outcome