Pattern of upper limb amputation associated with lower limb amputation: the UK military experience from Iraq and Afghanistan

• Published in: BMJ military health 2023-05, Vol.169 (e1), p.e20-e23
• Main Authors: McMenemy, Louise, Mondini, V, Roberts, D C, Kedgley, A, Clasper, J C, Stapley, S A
• Format: Article
• Language: English
• Subjects: Afghanistan; Amputation; Amputation, Surgical; Casualties; Fingers & toes; hand & wrist; Humans; Injuries; Iraq; limb reconstruction; Lower Extremity - injuries; Military Personnel; Original research; Patients; Prostheses; Quality of Life; Trauma; trauma management; United Kingdom; Upper Extremity - injuries
• ISSN: 2633-3767; 2633-3775
• DOI: 10.1136/bmjmilitary-2021-001783

IntroductionThe conflicts in Iraq and Afghanistan resulted in large numbers of personnel sustaining extremity injuries. In the context of polytrauma, partial hand amputation is often unrecorded. The aim of this work was to quantify the burden of upper limb (UL) amputation at any level occurring concurrently with a major (ankle and proximal) lower limb (LL) amputation. Knowledge of this cohort could aid in prosthetic modification to further improve quality of life outcomes in a population with dexterity loss.MethodA trauma database search was undertaken for all UK military LL amputees from the conflicts in Iraq and Afghanistan. A manual search method was employed to identify from the major LL amputees those who had a concurrent UL amputation at any level (including isolated finger amputation). Demographics, level of amputation, and injury profile data were recorded.ResultsSixty-eight individuals were identified; the most prevalent population was bilateral LL with a unilateral UL amputation (60%). Most UL amputations were partial hand (75%). The was no statistically significant difference between left or right side (p=0.13). On the left side, correlation was found between amputation of the thumb and third digit (rho=0.34; p=0.005) not seen on the right.ConclusionWe have determined the rate of UL amputation at any level, in combination with LL amputation as a result of blast injury. Knowledge of these combinations enables further research to support anecdotal evidence that there is a need for tailored prosthetics in the context of potential dexterity loss making donning and doffing problematic.