ORIGINAL
ARTICLE |
Epidemiological Features Of Extremity Traumatic Amputation In
Babol, North Of Iran |
Nasser
Janmohammadi*,Ali Bijani**
*Department of orthopedics, Shahid Beheshti Hospital, Babol medical
sciences university, Babol Iran.
** Department of Researches and Technology, Babol medical sciences
university , Babol Iran.
Address for Correspondence:
Nasser Janmohammadi,
Department of orthopaedics,
Shahid Beheshti hospital.
Babol medical sciences university,
Babol, Iran.
E-mail: dr_ Janmohammadi @ yahoo.com
Tel: +981113239565
Fax: +98111 2251664
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Abstract:
Objective: Trauma related amputation is the second most common
cause of extremity loss and is a devastating event and causes
many undesirable consequences. We aimed to determine
epidemiological features of extremity traumatic amputation in
Bobol north of Iran.
Material and Methods: Records of 358 cases with extremity
traumatic amputation who were admitted consecutively at the
department of Orthopedics of Bobol medical university from
January 1999 to September of 2007 were studied and their
epidemiological features were determined.
Results: On a total of 358 cases 301 (84%) were male and 250
(70%) were in age between 11 to 40 years .Traumatic amputation
was seen mostly in industrial (31%), agricultural (29%), and
motor vehicle accidents (24%) injuries. It also occurred more
often during spring (32.5%) and in the autumn (15%).Upper
extremity amputation was seen in 89.1% of cases and the hand (
88.8% )and its distal part ( finger) were the common site (85%)
of amputation .The frequency of amputation in the hand decreased
from distal phalanx (n=124) to metacarpal area ( n=1).
Conclusion: Extremity traumatic amputation was more prevalent
in young male, industrial and agricultural workers, motor
vehicle accidents, spring and autumn and upper extremity
especially its distal part.
J.Orthopaedics 2008;5(2)e14
Keywords:
Epidemiological features; Extremity; Traumatic Amputation.
Introduction:
Extremity traumatic amputation is a potentially devastating
event in a person’s life and often resulting in profound
physical, psychological and vocational consequences. Trauma
related amputation is the second most common cause of extremity
loss and occurs mostly in productive age of less than fifty
.Traumatic amputation usually results directly from work related
(occupational) injury, from factory (industrial), farm
(agricultural) or power tool accidents. It may be caused from
non-work related (non-occupational) injury, from motor-vehicle
accidents, housework and crush injuries. Natural disaster, war
and terrorist attacks can also cause traumatic amputation (1-3).
This study was conducted to determine the epidemiological
features of traumatic extremity amputation in our region.
Material and Methods :
In this retrospective study 358
cases with extremity traumatic amputation that were attended to
the department of orthopedics of Bobol medical university
consecutively between January 1999 to September 2007 were
evaluated. Data including sex; age; cause; site and time of
occurrence; involved extremity and segment were recorded.
Collected data were analyzed using SPSS software program.
Results :
In our study 358 (301 males and
57 females) patients with traumatic extremity amputation were
evaluated. Two hundred fifty (70%) were aged between 11 to 40
years. Two hundred twenty four (62.5%) had occupational related
injury and 134 (38%) had non-occupational injury (table1).
Table 1: Frequency of
traumatic amputation according to age and occupation in 358
cases.
Characteristic |
No(%) |
Age
(years) |
|
0-10 yr |
18 (5) |
11-20 yr |
64 (18) |
21-30 yr |
89 (25) |
31-40 yr |
97 (27) |
41-50 yr |
3 9(11) |
51-60 yr |
28 (8) |
Over 60 yr |
23 (5) |
Occupational |
224 (62.5) |
Industrial |
111 (31) |
Agricultural |
104 (29) |
Domestic accidents |
9 (2.5) |
Non-occupational |
134 (37.5) |
Motor – vehicle
accidents
Crush injuries |
86 (45)
34 (9.5) |
Others |
14 (4) |
Tow hundred fifteen (60%) were
amputated at the scene of accident, 93 (26%) were amputated
primary at the hospital because there was only some skin or
tendinous attachments and were not salvageable. Fifty (14%) were
amputated secondary due to failure of primary surgery. All
amputation sites (stump) were healed uneventfully. Temporal
distribution of cases was 32.5% in the spring, 22.5% in the
summer, 30% in the autumn and 15% in the winter. In the May
(spring) and in the September (summer) the amputation was more
prevalent with frequency of 50 (14%) and 47 (13%) respectively.
Upper extremity was affected in
319 (89%) of cases and 318 (88.8%) of amputation occurred in the
hand. Lower extremity amputation was seen in 39 (11%) cases
(table 2).
Table 2: Frequency of
traumatic amputation according to involved extremity in 358
cases.
Characteristic |
No (%)
|
Upper
extremity |
319(89) |
Hand |
318 (88.8) |
Wrist |
1 (0.2) |
Lower extremity
Toe |
39 (11)
32 (9) |
Below knee |
3 (0.8) |
Transfemoral |
2 (0.6) |
Transmetatarsal |
2 (0.6) |
Distribution of amputation in
the hand is detailed in table 3.One finger was amputated mostly
[170 (47%)] and thumb plus finger was amputated leastly [12
(3%)]. Amputation in the hand presented a decreasing order of
frequency from distal phalanx to metacarpal area. Distal part of
the hand (finger) was the most common site [305 (85%)] of
amputation.
Table 3: Distribution of traumatic amputation of the hand
according to involved finger and level of amputation in 358
cases.
Involved finger |
Total
(n=305) |
|
No (%) |
One finger |
170 (47) |
Two finger |
46 (13) |
Three and more
finger |
51 (14) |
Thumb |
26 (7) |
Thumb plus finger |
12 (3) |
Level of amputation |
No |
Distal phalanx |
135 |
Distal
interphangeal joint |
61 |
Middle phalanx |
49 |
Proximal interphalangeal
joint |
38 |
Proximal phalanx |
32 |
Metacarpophalangeal joint |
6 |
Transmetacarpal |
1 |
Discussion:
In the present study we determined the epidemiological features
of extremity traumatic amputation in our region generally. To
the best of our knowledge previous studies considered the
special characteristics of traumatic amputation in special
situations. So comparison of the results of our study with
previous studies seems to be not reasonable in some aspects.
The sex ratio in our study
(male>80%) is similar to other studies (4-6).
Traumatic amputation was seen
with increasing frequency from the second to fifth decades of
life. Liang et al (5) reported young male manufacturing workers
were at high risk of occupational amputation of upper
extremities. But Timothy et al (2) reported increasing risk of
amputation on those older than 85 years. Conn et al (7) observed
greatest risk of non-work related finger amputation in young
children and older adults in the United States.
More than 60% of our cases
sustained occupational related injury with high frequency in
industrial and agricultural works. This finding is compatible
with the results of Boyle et al (8), Onuba (9) and Stanbury et
al (10) researches. We found in the non-occupational group motor
vehicle accident was the most common cause (24.5%). This finding
is consistent with the result of Livingston et al (1) study.
With regard to temporal
distribution, we observed traumatic amputation was more frequent
in the spring and autumn and in the May and September. Spring
and autumn are planting and harvesting time and May and
September is the peak of planting and harvesting activities
respectively in our region. It was reported there are common
patterns of traumatic amputations in children based on the
mechanism of injury, the season and the age of the child (11).
A study from Hansen (12) showed highest incidence of major
injury due to agricultural machinery during spring planting (May
through June ) and fall harvesting (September through October )
time .
In our series upper extremity
was involved in 88.5% of cases which is higher than the finding
of Timothy et al (2). Hansen and Carstensen (13) demonstrated in
agricultural machinery injury, upper extremity was the most
common site of injury.
The hand and its distal part
(finger) sustained the most common traumatic amputation in our
cases. Timothy et al (2) research resulted that half of all
trauma – related amputation occurred in the upper extremity and
three quarter of all upper extremity traumatic amputation
occurred in the lower part of upper extremity (finger) Regarding
to involvement of individual finger , in the present study one
finger was amputated mostly and thumb plus finger the least .Triziolou
et al (14) showed hand injury of childrens with agricultural
machinery were most commonly associated with injury of third
digit and the thumb was the least. We found distal phalanx was
amputated most commonly. Doraiswamy and Baing (15) research
resulted in terminal phalanx was the most common injured (not
amputated) part in children.
It is concluded that extremity
traumatic amputation was more prevalent in young male ,
industrial and agricultural workers , motor vehicle accidents,
spring and autumn seasons and upper extremity especially its
distal part. With regard to these epidemiological
characteristics accordingly appropriate precaution measures may
decline the incidence or decrease the severity of extremity
traumatic amputation.
Acknowledgement:
We wish to acknowledge the personnel of records sections of
Shahid Beheshti and Shahid Yahyanejad Hospitals for their help
in data collection.
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This is a peer reviewed paper Please cite as
: Nasser Janmohammadi : Epidemiological Features
Of Extremity Traumatic Amputation In Babol, North Of Iran
J.Orthopaedics 2008;5(2)e14
URL:
http://www.jortho.org/2008/5/2/e14 |
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