title: Acute Limb Shortening for Major Near and Complete Upper Extremity Amputations with Associated Neurovascular Injury: A Review of the Literature.
abstract: In the setting a near or complete upper extremity amputations with significant soft tissue loss and neurovascular compromise, upper extremity surgeons are faced with the challenge of limb salvage. There are a multitude of treatment options for managing skeletal and soft tissue injuries including provisional fixation, staged reconstruction, and an acute shortening osteotomy with primary rigid internal fixation. However, many complications are associated with these techniques. Complications of provisional fixation include pin tract infection and loosening, tethering of musculotendinous units, nonunion, and additional surgeries. Staged reconstruction includes a variety of techniques: distraction osteogenesis, bone transport, or vascularized and non-vascularized structural autograft or allograft, but the risks often outweigh the benefits. Risks include nonunion, postoperative vascular complications necessitating reoperation, and the inability to return to the previous level of function at an average of 24 months. Acute shortening osteotomy with internal fixation offers the advantage of a single-stage procedure that provides for decreasing the soft tissue loss, provides a rigid platform to protect the delicate neurovascular repair, and alleviates unwanted tension at the repair sites. This review discusses the literature on the surgical treatment of severe upper extremity trauma with associated neurovascular injury over the past 75 years, and aims to evaluate the indications, surgical techniques, clinical and functional outcomes, and complications associated with acute shortening osteotomy with rigid internal fixation. Although this technique is not without risks, it is well-tolerated in the acute setting with a complication profile comparable to other techniques of fixation while remaining a single procedure.
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Kusnezov
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Dunn
authors.affiliation: Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Stewart
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Beaumont Army Medical Center, El Paso, Texas, USA.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Mitchell
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA.
authors.forename: Miguel
authors.initials: M
authors.lastname: Pirela-Cruz
mesh_terms: D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D001134:Arm Injuries / Q000601:surgery; D005592:Fracture Fixation / Q000379:methods; D006801:Humans; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D010027:Osteotomy / Q000379:methods; D017695:Soft Tissue Injuries / Q000601:surgery; D034941:Upper Extremity / Q000293:injuries* / Q000601:surgery; D057772:Vascular System Injuries / Q000601:surgery*
keywords: Amputations; Limb shortening; Neurovascular injury; Shortening osteotomy; Upper extremity