Direct Skeletal Fixation in bilateral above knee amputees following blast: 2 year follow up results from the initial cohort of UK service personnel
| Autor: | J.M. Kendrew, Rhodri Phillip, Alan Mistlin, Kate Sherman, L McMenemy, Arul Ramasamy, Demetrius Evriviades |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Artificial Limbs Walk Test Walking Prosthesis Design Prosthesis Amputation Surgical Prosthesis Implantation Young Adult 03 medical and health sciences 0302 clinical medicine Blast Injuries Fracture Fixation Osseointegration medicine Humans Skeletal fixation Patient Reported Outcome Measures Retrospective Studies General Environmental Science Leg 030222 orthopedics Rehabilitation business.industry 030208 emergency & critical care medicine medicine.disease Polytrauma United Kingdom Surgery Radiography Amputation Cohort General Earth and Planetary Sciences Patient-reported outcome Implant business Follow-Up Studies |
| Zdroj: | Injury. 51:735-743 |
| ISSN: | 0020-1383 |
| Popis: | Aims The aim of the study is to evaluate the clinical outcome and complications from the initial cohort of blast injured bilateral lower limb, above knee amputees who underwent Direct Skeletal Fixation (DSF). Patients and methods We undertook a retrospective analysis of a prospective data base identifying patients who had undergone implantation with the Australian Osseointegration Group of Australia-Osseointegration Prosthetic Limb (OGAP-OPL) prosthesis, with minimum 24 months follow up. Patient demographics, injury profile, and polymicrobial colonisation status were recorded. Physical functional performance measures recorded were the 6 minute Walk Test (6-MWT) and patient reported outcome measures were the Short Form Health Survey-36 (SF-36). Post operatively, complications including infection, re-operation, and fracture were recorded. Results 7 patients (14 femora) were identified (mean age 29.8yrs), all injured by dismounted blast. Mean follow up was 46 months. All were polytrauma patients and all had previous polymicrobial colonisation. Following surgery, all patients mobilised with significant improvement in 6-minute walk time, with a mean improvement of 154 m (248 m vs 402 m, p = 0.018). The physical component score for the SF-36 demonstrated a statistically significant improvement from 34.65 to 54.5 (p = 0.018) and the mental component score demonstrated a similar improvement (41.55–58.19 p = 0.018). At follow up, no patient required explantation of the implant. Each had been prescribed a minimum of 1 course of antibiotics with no evidence of deep infection. Conclusion DSF is an option for amputees who, due to the nature of their injuries, may not be able to tolerate traditional suspension socket prostheses and have exhausted all other treatment options. At a minimum of 2 year follow up, the absence of significant infective complications suggests DSF may be utilised in the blast injured despite chronic polymicrobial colonisation. Longer term surveillance of these patients is required to assess the long-term suitability of this technique in this cohort of patients. |
| Databáze: | OpenAIRE |
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