title: Common factors and outcome in late upper extremity amputations after military injury.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Tertiary trauma center.
  
  
  METHODS
  All US service members who sustained major extremity amputations from September 2001 to July 2011 were analyzed.
  
  
  METHODS
  Late (>90 days after injury) upper extremity amputations.
  
  
  METHODS
  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.
authors.affiliation: *Department of Orthopaedic Surgery, San Antonio Military Medical Center, Ft Sam Houston, TX; †United States Army Institute of Surgical Research, Department of Extremity Trauma and Regenerative Medicine, Ft Sam Houston, TX; and ‡Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC.
authors.forename: Chad A
authors.initials: CA
authors.lastname: Krueger
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Wenke
authors.forename: Mickey S
authors.initials: MS
authors.lastname: Cho
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Hsu
mesh_terms: D000671:Amputation, Surgical / Q000009:adverse effects*; D001134:Arm Injuries / Q000150:complications / Q000601:surgery*; D006801:Humans; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014857:Warfare