Barri L. Schnall, MPT, LT Scott C. Wagner, MD, Jenna D. Montgomery, BS, Marilynn Wyatt, PT, MA,
and MAJ Benjamin K. Potter, MD
The current conflicts in Iraq and Afghanistan have produced
a large number of service members with severe
combat-related injuries. Eighty-two percent of service
members with combat-related injuries have sustained extremity
trauma, which accounts for 54% of wounds overall1.
Of all the lower-extremity amputations performed at military
treatment facilities, approximately 13% (125 of 975) were the
result of delayed or ''elective'' procedures2. Recent studies have
shown that the outcomes of extensive salvage procedures for
severely injured limbs are not necessarily definitive in a nonmilitary
population3 and that early amputation can be preferable
to limb salvage in many such instances3-12.
Some military and nonmilitary population studies have
considered a delayed amputation as occurring within as little as
twenty-four hours postinjury, while other studies have cited a
range over years4,13,14. Up to 15% of combat-related amputations
have occurred later than twelve weeks postinjury, and the military
medical community has adopted this as a reasonable timeframe
during which initial operative efforts at limb salvage can be attempted
2,14. Given the incidence of trauma-related amputation in
the active duty military population, as well as the likely underreported
frequency of similar scenarios in civilian trauma settings
3,8,15-17, the goal of this report is to provide an analysis of gait in
combat-injured patients before and after delayed amputation.
Our institutional review board approved the retrospective review
of the data presented in this manuscript. The three patients included
in this case series were informed that data would be submitted
for publication, and they all gave consent.
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