Major limb amputations: a 5year retrospective study in a regional trauma centre

Abstract

Objective: The aim of this study is to establish the pattern of amputation in our environment, analyze the procedures done and outcome, compare our findings with various reports coming out from developing countries namely, indication, level of amputation, rehabilitation and outcome and recommend ways of mitigation and improved outcome.
Methodology: This is a retrospective study in whichcase histories of patients that had undergone amputations at National Orthopaedic Hospital Enugu (NOHE), Nigeria over 5 year period (Jan 1 2011 – Dec 31 2015) were reviewed.
Results: Results showed: There were forty – six (46) patients with forty seven (47) amputations, thirty-eight (38) (82.61%) were males and eight (8) (17.39%) Females with M.F ratio of 4:75:1. The Mean Age (in years) was 36.6 ± 17.08 with a of Range 1 – 90 (yrs) Eight (8) (17.39%) of the patients were diabetic and the remaining thirty eight (38) (82.6%) were non diabetic patients. Thirty three (33) (70.21%) of these amputations were in the lower limb while fourteen (14) (29.79%) were in the upper Limb. There was a re-amputation in five (50 (10.87%) patients. Twenty four (24)(52.17%) patients had complications.
Discussion: Six of the patients died representing a mortality rate of 13.04%. Seventeen (17) (36.96%) patients were rehabilitated with prosthesis. The highest indication in our series is due to gangrene secondary to diabetic foot followed closely by mismanaged tibia fractures by the Traditional Bone Setters (TBS) and poor wound management by doctors.
Conclusion: Most of our amputations are above knee with phantom limb as the most noted complications. Out rate of rehabilitation is quite low. We therefore recommend the following: continued education for doctors on wound management and management of diabetic foot, regulation and education of practice of Traditional Bone Setters to enable them recognize and not exceed their limits, development, equipping and capacity building for prosthetic units to enable them meet with the challenges facing the amputee, further studies to establish the real cause of low rate of rehabilitation.

Keywords -Amputation, Complications, Developing Country, Indications, and Rehabilitation