Rehabilitation of Amputations in Disasters and Conflicts

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Introduction

Natural disasters and mass casualties that occur during military conflicts or industrial accidents can cause musculoskeletal trauma among military and civilian populations involved in these disasters.As a result of crush injury, crush syndrome or compartment syndrome a different than non-disaster approach to amputations may be warrant.

Types of Amputations

The level of amputation defines different types of lower and upper limbs amputations

Upper Limb Amputations

Shoulder level:

• Shoulder disarticualtion
• Amputation of the arm, scapula and clavical (Forequater)

Elbow level:

• Above elbow (Transhumeral)
• Elbow disarticulation
• Below elbow (Transradial)

Wrist and Hand level:

• Partial hand (Transcarpal)
• Hand and Wrist disarticulation

Lower Limb Amputations

Hip level:

• Hip disarticulation
• Amputation of the leg and pelvis (Hemipelvectomy)

Knee level:

• Above knee amputation (Transfemoral)
• Knee disarticulation
• Below knee amputation (Transtibial)

Foot and Ankle:

• Ankle dysarticulation
• Partial foot (Chopart)
• Syme's

Initial Trauma Care

In disaster situations the following principles of trauma care are often critical: rapid triage, transport, early stabilisation, and definitive management.

Rapid Triage

Life saving is a primary purposes of limb amputation during the disaster as the wounds sustained at the batter field are usually

Medical and Surgical Intervention Considerations

Considerations for Amputations

Prehospital field amputations may improve patient outcome

In the emergency and disaster medicine literature, it’s generally accepted to amputate the limb as distally as possible.4,6,7 This is consistent with the steering committee recommendations set forth in 2011 by the International Search and Rescue Advisory Group (INSARAG).

principles of trauma care such as rapid triage, transport, early stabilisation and definitive management is critically important in disaster situations. Battlefield extremity wounds are typically characterised by high-energy injury, extensive soft-tissue damageand prolonged injury-to-operation time. During earthquakes and other mass-casualty events, the mechanism of injury is primarily low-energy, prolonged, crushing trauma, with extensive soft tissue damage and late presentation.Both these varieties of factors lead to an increased risk of infection and higher levels of amputation

Trauma complications:

• crush injury
• crush syndrome Crush syndrome (CS) is a condition with a high morbidity and mortality due to severe electrolyte disorders, circulatory dysfunction and multiple organ failure, secondary to severe rhabdomyolysis and reperfusion injuries. There is controversy about the role of fasciotomy in the treatment of compartment syndromes due to crush injuries and it is still unknown if early amputation has patient-centered benefits.
• compartment syndrome

Healing Considerations

Assessment Considerations

Treatment Considerations

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References 

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