[Evaluation of macroamputations of the upper extremity in the management of primary malignant bone and soft-tissue tumours using the DASH score].
OBJECTIVE
The purpose of this retrospective analysis was to identify patients with macroamputations of the upper extremity due to malignant bone or soft-tissue tumours at a single institution. The German DASH score (Disability of Arm, Shoulder, Hand) was obtained in order to measure how patients manage their daily activities.


METHODS
Between 1998 and 2005, 1652 patients were operated due to a bone or soft-tissue tumour, 370 of these due to a malignant one (22 %). The tumour was localised in the lower extremity or in the pelvis in 246 cases, in the trunk in 38 and in the upper extremity in 86 cases. These 86 primary malignant tumours comprised 22 bone and 64 soft tissue tumours. Amputations had to be performed in the lower extremity in 14 % (35/246) and in the upper extremity in 7 % (6/86). Six patients with macroamputations of the upper extremity were identified and in five of these the DASH score was obtained.


RESULTS
The mean DASH score for the module 1 (disability/symptom) was 75.1 points ([sum of responses - 30]/1.2), for module 2 (work) 92.4 ([sum of responses - 4]/0.16), and for module 3 (sports/performing arts) 90 points ([sum of responses - 4]/0.16). Only two patients worked again and only one played an instrument.


CONCLUSIONS
Despite neo-/adjuvant therapeutic options and modified reconstructive procedures 7 % of patients with malignant bone or soft tissue tumours of the upper extremity had to undergo an amputation. The DASH score is an appropriate instrument to measure the disability after upper limb amputation due to tumour.
Leithner
A
A
Universitätsklinik für Orthopädie, Medizinische Universität Graz, Auenbruggerplatz 5, Graz, Austria. andreas.leithner@meduni-graz.at
Glehr
M
M
Scheipl
S
S
Windhager
R
R
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D001132:Arm / Q000601:surgery*; D001186:Artificial Limbs; D001859:Bone Neoplasms / Q000601:surgery*; D002813:Chondrosarcoma / Q000601:surgery*; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007890:Leiomyosarcoma / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010591:Phantom Limb; D010954:Plasmacytoma / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D012509:Sarcoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013584:Sarcoma, Synovial / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000601:surgery*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome