Pattern of limb amputations in Liberia.

Background: Amputation is one of the oldest known surgical procedures. It has been one of the modalities of applying judgment and treatment. Its method and indications has evolved over time. Modern amputation is regarded as a part of treatment rather than failure of treatment. Amputation is the removal of a limb or part of a limb through on or more bone. When through a joint is referred to as disarticulation. Data on the profile and pattern of amputation in Liberia will add to the body of knowledge. Aim and Objectives: Is to describe the pattern of limb of amputations in Liberia. Also to describe the anatomical variations of limb amputations in Liberia. Patients and Method: A retrospective study of all patients that underwent limb amputation surgeries in the John F Kennedy Memorial (JFK M), Hospital , Monrovia Liberia between January 2010 to December 2015. Results: 100 patients had limb amputations between 2010 and 2015. Males(73) to female(27) ratio were 2.4:1. The age range was 9 - 91 years. Mean age was 42.9 years. The indications for amputations were Trauma 24%, Diabetes 29%, Gangrene (6%), Chronic ulcer (25%), Tumour (5%). Below knee(47%), Above Knee(45%), Below elbow(2%), Above Elbow(2%), Knee Disarticulation(2%), and Big Toe Disarticulation(2%). Conclusion: The profile of Limb amputation in Liberia is not very different from what is obtaining in the region. However the limitations of histology and other investigative procedure have affected the accurate diagnosis of certain conditions like tumours.

RésuméContexte: L amputation est l'une des vieilles interventions chirurgicales connues. Elle a ete une des modalitees exigeant un choix judicieux et le traitement adequat. Ses methodes et indications ont evoluer aucours de temps. L' amputation moderne est consideree comme faisant partie du traitement plutot que de l' echec therapeutique. L amputation est definie comme l' ablation d' un member ou d une partie de membre au a travers d' un ou des plusieurs os. Quand ,elle se fait au niveau d'une articulation, celle ci s' appellee la desarticulation. Les donnees sur le profil et structure de l amputation au Liberia ajouteront un plus de conaissance au corps academique. But et objectifs: C' est de decrire le mode d'amputation du member au Liberia; Ainsi que ses variations anatomiques. Patients et Methode: Une etude retrospective de tous les Patients ayant subit l' amputation chirurgicale du membre a John F kennedy Memorial Hospital, Monrovia, Liberia entre janvier 2010 jusque decembre 2015. Resultas: 100 patients ont subit les amputations entre 2010 et 2015. Males :73, Femeles: 27, Sexe ratio :2.4/1, Tranche d 'age :9-91ans, Age moyen: 42,9 ans, Indications des amputations: Diabetes:29%, Ulceres chroniques:25%, Traumatisme: 24%, Gangrene: 6%, Tumeures: 5%, Au dessous du genou: 47%, Au dessus du genoux: 45%, En dessous du coude: 2%, Au dessus du coude:2%, Disarticulation du genou: 2%, Desarticulation du gros orteil : 2%. Conclusion: Le profil sur les amputations des membres au Liberia n' est pas tres different de ce obtenu dans la region. Cependant ,carence en histologie et autres investigatios paracliniques ont affectees le diagnostique precis des certaines conditions comme les tumeurs.

Lower limb amputation in Northern Netherlands: unchanged incidence from 1991-1992 to 2003-2004.

BACKGROUND: Investigating population changes gives insight into effectiveness and need for prevention and rehabilitation services. Incidence rates of amputation are highly varied, making it difficult to meaningfully compare rates between studies and regions or to compare changes over time. STUDY DESIGN: Historical cohort study of transtibial amputation, knee disarticulation, and transfemoral amputations resulting from vascular disease or infection, with/without diabetes, in 2003-2004, in the three Northern provinces of the Netherlands. OBJECTIVES: To report the incidence of first transtibial amputation, knee disarticulation, or transfemoral amputation in 2003-2004 and the characteristics of this population, and to compare these outcomes to an earlier reported cohort from 1991 to 1992. METHODS: Population-based incidence rates were calculated per 100,000 person-years and compared across the two cohorts. RESULTS: Incidence of amputation was 8.8 (all age groups) and 23.6 (≥45 years) per 100,000 person-years. This was unchanged from the earlier study of 1991-1992. The relative risk of amputation was 12 times greater for people with diabetes than for people without diabetes. CONCLUSIONS: Investigation is needed into reasons for the unchanged incidence with respect to the provision of services from a range of disciplines, including vascular surgery, diabetes care, and multidisciplinary foot clinics. CLINICAL RELEVANCE: This study shows an unchanged incidence of amputation over time and a high risk of amputation related to diabetes. Given the increased prevalence of diabetes and population aging, both of which present an increase in the population at risk of amputation, finding methods for reducing the rate of amputation is of importance.

Functional outcome of hip disarticulation and hemipelvectomy: a cross-sectional national descriptive study in the Netherlands.

OBJECTIVE: To describe characteristics of hip disarticulation and hemipelvectomy amputees, to assess their level of activities, participation and experienced limitations in mobility and to describe the amputation-related problems. DESIGN: A cross-sectional study. SETTING: Patients were mainly recruited via orthopaedic workshops in the Netherlands. SUBJECTS: Forty-six patients with an acquired unilateral hip disarticulation or hemipelvectomy at least one year post amputation. MAIN OUTCOME MEASURES: Sickness Impact Profile 68 (SIP 68) to assess the level of activity and participation and the questionnaire Rising and Sitting Down, Walking and Climbing Stairs to assess perceived limitations in mobility. RESULTS: The 46 patients (31 with hip disarticulation and 15 with hemipelvectomy) had a mean age of 55.8 years (SD 12.1). In 78% of cases the reason for amputation was a tumour. Mean SIP 68 was low, 10.5 (SD 6.9). Hip disarticulation amputees had significantly poorer emotional stability than the hemipelvectomy amputees (P = 0.04). All amputees experienced considerable limitations in their mobility according to the Rising and Sitting Down, Walking and Climbing Stairs scores. CONCLUSIONS: Hip disarticulation and hemipelvectomy amputees have a relatively high level of activity and participation (SIP scores) but at the same time experience limitations in walking, rising and sitting down and climbing stairs.

Lower limb amputation in three Australian states.

A study has been made of lower limb amputation statistics from morbidity data from the State Health Departments in New South Wales, Queensland, and Western Australia. The incidence of lower limb amputation in these three States was 22.6 in 1981, 22.5 in 1983, and 23.6 in 1984. Incidence was lowest in New South Wales and highest in Western Australia. Below-knee amputation was more common than above-knee except in Western Australia in the years 1981 and 1983. Males had slightly more amputations than females. Incidence increased steadily with age, rising rapidly after 55 years. Vascular disease was the most common cause of major amputation. Of malignancies, skin cancers, both malignant melanoma and other forms, were causes of major and minor amputations in addition to bone malignancies. These three Australian States have a lower incidence of amputation than the United Kingdom or Finland.