Traumatic and trauma-related amputations: Part II: Upper extremity and future directions.

Trauma is the most common reason for amputation of the upper extremity. The morphologic and functional distinctions between the upper and lower extremities render the surgical techniques and decision-making different in many key respects. Acceptance of the prosthesis and the outcomes are improved by performing a transradial rather than a more proximal amputation.

Traumatic and trauma-related amputations: part I: general principles and lower-extremity amputations.

Deliberate attention to the management of soft tissue is imperative when performing an amputation. Identification and proper management of the nerves accompanied by the performance of a stable myodesis and ensuring robust soft-tissue coverage are measures that will improve patient outcomes. Limb length should be preserved when practicable; however, length preservation at the expense of creating a nonhealing or painful residual limb with poor soft-tissue coverage is contraindicated.

Outcomes associated with the internal fixation of long-bone fractures proximal to traumatic amputations.

Background: Preservation of optimal residual limb length following a traumatic amputation can be challenging. The purpose of this study was to determine if acceptable results can be achieved by definitive fixation of a long-bone fracture proximal to a traumatic amputation.

Methods: We identified thirty-seven active-duty military service members who underwent internal fixation of a long-bone fracture proximal to a traumatic amputation.

Squamous cell carcinoma of the foot.

Background: Squamous cell carcinomas (SCC) of the foot are relatively common, but have been infrequently reported in the orthopaedic literature.

Materials And Methods: Twelve patients with SCC of the foot treated at a single institution from 1998 to 2005 were studied retrospectively with regard to risk factors for the disease, treatment, and functional and oncologic outcomes. The mean duration of postoperative followup was 43 (range, 24 to 105) months.

Heterotopic ossification following traumatic and combat-related amputations. Prevalence, risk factors, and preliminary results of excision.

Background: Although infrequently reported in amputees previously, heterotopic ossification has proven to be a common and problematic clinical entity in our recent experience in the treatment of traumatic and combat-related amputations related to Operation Enduring Freedom and Operation Iraqi Freedom. The purpose of the present study was to report the prevalence of and risk factors for heterotopic ossification following trauma-related amputation as well as the preliminary results of operative excision.

Methods: We identified 330 patients with a total of 373 traumatic and combat-related amputations who had been managed at our centers between September 11, 2001 and November 30, 2005.

Solitary epiphyseal enchondromas.

Background: Enchondromas originating in the epiphyses of long bones are rare. The purpose of the present study was to evaluate the prevalence as well as the radiographic and clinical characteristics of epiphyseal enchondromas among patients who had been referred to the Armed Forces Institute of Pathology and Walter Reed Army Medical Center.

Methods: We performed a retrospective review of 761 patients who had been referred to our two institutions over an approximately fifty-five-year period and who received a final diagnosis of enchondroma.

Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement.

Background: Arthroscopic debridement is the standard of care for the treatment of acetabular labral tears. The Short Form-36 has not been used to measure hip arthroscopy outcomes, and the impact of disability status on hip arthroscopy outcomes has not been reported.

Hypothesis: Short Form-36 subscale scores will demonstrate good correlation with the modified Harris hip score, but patients undergoing disability evaluation will have significantly worse outcome scores.