title: Characterisation and outcomes of upper extremity amputations.
abstract: BACKGROUND
  The purpose of this study is to characterise the injuries, outcomes, and disabling conditions of the isolated, combat-related upper extremity amputees in comparison to the isolated lower extremity amputees and the general amputee population.
  
  
  METHODS
  A retrospective study of all major extremity amputations sustained by the US military service members from 1 October 2001 to 30 July 2011 was conducted. Data from the Department of Defense Trauma Registry, the Armed Forces Health Longitudinal Technology Application, and the Physical Evaluation Board Liaison Offices were queried in order to obtain injury characteristics, demographic information, treatment characteristics, and disability outcome data.
  
  
  RESULTS
  A total of 1315 service members who sustained 1631 amputations were identified; of these, 173 service members were identified as sustaining an isolated upper extremity amputation. Isolated upper extremity and isolated lower extremity amputees had similar Injury Severity Scores (21 vs. 20). There were significantly more non-battle-related upper extremity amputees than the analysed general amputation population (39% vs. 14%). Isolated upper extremity amputees had significantly greater combined disability rating (82.9% vs. 62.3%) and were more likely to receive a disability rating >80% (69% vs. 53%). No upper extremity amputees were found fit for duty; only 12 (8.3%) were allowed continuation on active duty; and significantly more upper extremity amputees were permanently retired than lower extremity amputees (82% vs. 74%). The most common non-upper extremity amputation-related disabling condition was post-traumatic stress disorder (PTSD) (17%). Upper extremity amputees were significantly more likely to have disability from PTSD, 13% vs. 8%, and loss of nerve function, 11% vs. 6%, than the general amputee population.
  
  
  CONCLUSIONS
  Upper extremity amputees account for 14% of all amputees during the Operation Enduring Freedom and Operation Iraqi Freedom conflicts. These amputees have significant disability and are unable to return to duty. Much of this disability is from their amputation; however, other conditions greatly contribute to their morbidity.
authors.affiliation: San Antonio Military Medical Center, Department of Orthopaedics and Rehabilitation, 3851 Rogers Brooke Drive, Fort Sam Houston, TX 78234, USA. Electronic address: david.tennent@us.army.mil.
authors.forename: David J
authors.initials: DJ
authors.lastname: Tennent
authors.affiliation: United States Institute of Surgical Research, 3698 Chambers Pass JBSA Ft, Sam Houston, TX 78234, USA. Electronic address: joseph.c.wenke@mail.mil.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Wenke
authors.affiliation: United States Institute of Surgical Research, 3698 Chambers Pass JBSA Ft, Sam Houston, TX 78234, USA. Electronic address: jessica.c.rivera14.mil@mail.mil.
authors.forename: Jessica C
authors.initials: JC
authors.lastname: Rivera
authors.affiliation: San Antonio Military Medical Center, Department of Orthopaedics and Rehabilitation, 3851 Rogers Brooke Drive, Fort Sam Houston, TX 78234, USA. Electronic address: chad.a.krueger4.mil@mail.mil.
authors.forename: Chad A
authors.initials: CA
authors.lastname: Krueger
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000671:Amputation, Surgical / Q000523:psychology / Q000534:rehabilitation*; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology / Q000534:rehabilitation / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008889:Military Personnel / Q000523:psychology / Q000706:statistics & numerical data; D063868:Patient Outcome Assessment; D012179:Retirement / Q000523:psychology / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology / Q000534:rehabilitation*; D015599:Trauma Severity Indices; D014481:United States; D034941:Upper Extremity / Q000293:injuries*; D014947:Wounds and Injuries / Q000523:psychology / Q000534:rehabilitation* / Q000601:surgery
keywords: Disability; Military; Return to duty; Upper extremity amputation