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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 @
Tel: +981113239565
Fax: +98111 2251664



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

Epidemiological features; Extremity; Traumatic Amputation.

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.



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)


224 (62.5)


111 (31)


104 (29)

          Domestic accidents

9 (2.5)


134 (37.5)

          Motor – vehicle accidents

          Crush injuries

86 (45)

34 (9.5)


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.


No (%)

Upper extremity



318 (88.8)


1 (0.2)

  Lower extremity


39 (11) 

32 (9)

          Below knee

3 (0.8)


2 (0.6)


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)


26 (7)

          Thumb plus finger

12 (3)

Level of amputation


          Distal phalanx


          Distal interphangeal joint


Middle phalanx


Proximal interphalangeal joint


Proximal phalanx


Metacarpophalangeal joint




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.  

We wish to acknowledge the personnel of records sections of Shahid Beheshti and Shahid Yahyanejad Hospitals for their help in data collection.

Reference :

  1. Livingston DH, Keenan D, Kim D, Eleavage J, Malangoni MA. Extent of disability following traumatic extremity amputation. J Trauma 1994; 37 (3): 495-9.

  2. Timothy R. Dillingham, MD, Liliana E. Pezzin, PhD, Ellen J.Mackenzie, PhD. Extremity Amputation and Limb Deficiency. South Med J 2002; 95(8) : 875-883.

  3. Medline plus Medical Encyclopedia: Amputation–traumatic. Available at: Accessed on 5 February 2008.

  4. Sorock GS, Smith E. Hall N. Hospitalized occupational finger amputations, New Jersey, 1985 and 1986. Am J Ind Med 1993; 23(3): 439-47.

  5. Liang HW, Chen SY , Hsu JH,Chung CW. Work-related upper extremity amputation in Taiwan,1999-2001. Am J Ind Med 2004; 46(6): 649-55.

  6. Atroshi I, Rosberg HE. Epidemiology of amputations and severe injuries of the hand. Hand Clin 2001; 17(3): 343-50,

  7. Conn JM, Annest JL Ryan Gw, Budnitz DS. Non –work related finger amputations in the united states, 2001 –2002. Ann Emerg Med 2005; 45(6): 636-8.

  8. Boyle D , parker D , Larson C, Pessoa-Brandao L. Nature , incidence , and causes of work-related amputations in Minnesota. Am J Ind Med 2000 37(5) : 542-50.

  9. Onuba O. Traumatic finger amputations in Bulawayo. Cent Afr J Med 1993; 39(3): 49-52.

  10. Stanbury M, Reilly MJ, Rosenman KD. Work-related amputations in Michigan, 1997 Am J Ind Med 2003; 44(4): 359-67.

  11. Loder RT. Demographics of traumatic amputations in children. Implications for prevention strategies. J Bone Joint Surg Am 2004; 86-A (5): 923-8.

  12. Hansen RH. Major injuries due to agricultural machinery. Ann Plast Surg 1986; 17(1):59-64.

  13. Hansen TB. Carstensen O. Hand injuries in agricultural accidents.1999 Hand Surg (Br) 1999; 24(2): 190-2.

  14. Terzioglu A, Aslan G. Ates L. Injuries to children’s hands caused be the engine belts of agricultural machines: classification and treatment. Scand J Plast Reconstruct Surg Hand Surg 2004; 38(5) 297 – 300.

  15. Doraiswamy NV, Baig H. Isolated finger injuries in children -- incidence and aetiology. Injury 2000; 31 (8): 571-3.



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





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