A study in the January 2013 edition of the Journal of Bone & Joint Surgery concluded that military service members who undergo amputation appear to have better functional outcomes than those who undergo limb salvage, but cautioned that the results have the potential for selection bias.
Researchers conducted a retrospective study of 324 service members deployed to Afghanistan or Iraq who sustained a lower-limb injury requiring either amputation or limb salvage involving revascularization, bone graft/bone transport, local/free flap coverage, repair of a major nerve injury, or a complete compartment injury/compartment syndrome.
Several areas of function were measured. Those functions and the measurement instruments follow:
- Overall function: Short Musculoskeletal Function Assessment (SMFA)
- Depression: Center for Epidemiologic Studies Depression Scale
- Posttraumatic stress disorder (PTSD): PTSD Checklist-Military Version
- Chronic pain: Chronic Pain Grade Scale
- Engagement in sports and leisure activities: Paffenbarger Physical Activity Questionnaire
The outcomes of amputation and salvage were compared by using regression analysis with adjustments for age, time until the interview, military rank, upper-limb and bilateral injuries, social support, and intensity of combat experiences.
The total response rate was 59.2 percent. The response rate for individuals who underwent amputation was 64.5 percent while the response rate for those treated with limb salvage was 55.4 percent. In all SMFA domains except arm/hand function, the patients scored significantly worse than population norms.
After adjustment for covariates, participants with an amputation had better scores in all SMFA domains compared with those whose limbs had been salvaged. They also had a lower likelihood of PTSD and a higher likelihood of being engaged in vigorous sports. There were no significant differences between the groups with regard to the percentage of patients with depressive symptoms, pain interfering with daily activities, or work/school status.
More details about the study can be found at The Military Extremity Trauma Amputation/Limb Salvage (METALS) Study: Outcomes of Amputation Versus Limb Salvage Following Major Lower-Extremity Trauma.
