title: Ten years at war: comprehensive analysis of amputation trends.
abstract: BACKGROUND
  While multiple studies have examined amputations that have occurred during the current conflicts in Iraq and Afghanistan, none of these studies have provided an overarching characterization of all of these injuries.
  
  
  METHODS
  A retrospective study of all major extremity amputations sustained by US Service Members from January 2001 through July 30, 2011, was performed. Data obtained from these amputees included amputation level(s), mechanism of injury, time to amputation, Injury Severity Score (ISS), age, rank, number of trauma admissions, and number of troops deployed.
  
  
  RESULTS
  There were 1,221 amputees who met inclusion criteria. These amputees sustained a total of 1,631 amputations. The number of amputations performed each year has increased dramatically in 2010 (196) and the first half of 2011 (160) from 2008 (105) and 2009 (94). The number of amputations performed per every 100 traumatic admissions (3.5-14) and the number of amputations per 100,000 deployed troops (2-14) has also increased in 2010 and the first half of 2011. Most amputations occurred at the transtibial (683, 41.8%) and transfemoral (564, 34.5%) levels. Thirty percent of the amputees (366) sustained multiple amputations, and 14% of all amputations (228) performed involved the upper extremity. There were 127 amputees (10%) who underwent their amputation more than 90 days after the date of injury.
  
  
  CONCLUSIONS
  The number of amputations occurring during the current Iraqi and Afghanistan conflicts has increased in 2010 and the first half of 2011. Most amputations involve the lower extremities, and there is a much higher percentage of amputees who have sustained multiple amputations during current operations than previous conflicts.
  
  
  METHODS
  Epidemiologic study, level IV.
authors.affiliation: Brooke Army Medical Center, Fort Sam Houston, Texas, USA. chad.krueger@amedd.army.mil
authors.forename: Chad A
authors.initials: CA
authors.lastname: Krueger
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Wenke
authors.forename: James R
authors.initials: JR
authors.lastname: Ficke
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000671:Amputation, Surgical / Q000379:methods / Q000706:statistics & numerical data*; D000673:Amputation, Traumatic / Q000453:epidemiology / Q000601:surgery*; D001134:Arm Injuries / Q000453:epidemiology / Q000601:surgery; D015331:Cohort Studies; D016208:Databases, Factual; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D054542:Iraq War, 2003-2011; D007869:Leg Injuries / Q000453:epidemiology / Q000601:surgery; D008297:Male; D054527:Mass Casualty Incidents / Q000401:mortality / Q000706:statistics & numerical data*; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data; D009104:Multiple Trauma / Q000453:epidemiology* / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014857:Warfare; D055815:Young Adult