OTA 2009 Posters
Scientific Poster #95 Tibia OTA-2009
Osteomyoplastic and Traditional Transtibial Amputations in the Trauma Patient: Perioperative Comparisons and Subjective Outcomes
Benjamin C. Taylor, MD1 (n); Bruce G. French, MD2 (n); Atilla Poka, MD2 (5A-Biomet);
Andrew Blint, MD3 (n); Kevin W. Pugh, MD2 (5-Smith and Nephew Consultant);
1Mount Carmel Medical Center, Columbus, Ohio, USA;
2Grant Medical Center, Columbus, Ohio, USA;
3Rockford Memorial Hospital, Rockford, Illinois, USA
Purpose: Our objective was to retrospectively evaluate and compare transtibial amputation osteomyoplasty and traditional transtibial amputation patient populations, with specific attention to perioperative complications and functional outcomes.
Methods: Treatment included transtibial amputation osteomyoplasty or traditional transtibial amputations by fellowship-trained orthopaedic traumatology surgeons at a regional Level 1 trauma center as a result of high-energy trauma or other postoperative complications. Retrospective chart and radiographic review of initial injury, treatment, and postoperative follow-up course were performed. Additional functional outcomes were then measured using the Sickness Impact Profile (SIP) questionnaire, a validated objective quality of life measurement instrument.
Results: 26 patients who underwent transtibial amputation osteomyoplasty are compared to 10 patients with traditional transtibial amputations. The average age of the patients was 42.7 years (range, 18-83 years). There was a significant increase in acute fractures in the traditional transtibial amputation population (P <0.01) due to the inclusion of several amputation osteomyoplasty patients being referred from remote trauma and its sequelae. Similarly, the length of time from injury to definitive amputation was significantly longer in the amputation osteomyoplasty group. However, the number of previous procedures was not significantly different. Operative time was roughly doubled from an average of 75.8 minutes to 153.8 minutes when performing the amputation osteomyoplasty. Estimated blood loss revealed no differences between groups. Final clinical follow-up at an average of 13.8 months revealed a significantly greater employment rate in the osteomyoplasty group (46% vs 10%) and a significantly decreased rate of walking aid usage (15% vs 70%) as compared to the traditional amputation group. A nonsignificant trend of decreased subsequent ipsilateral stump procedure rate was noted in the osteomyoplasty group; a significant decrease in the stump revision rate was seen in this group, however. Trends of less postoperative time to temporary and permanent prosthesis fitting were seen in the osteomyoplasty group. SIP questionnaire findings included significantly lower overall and physical dimension subset scores in the amputation osteomyoplasty group.
Conclusion: Based on the results of this study, transtibial amputation osteomyoplasty appears to be safe in this trauma population. Several subjective and objective advantages to amputation osteomyoplasty are noted in this small patient group.
Disclosure: (n=Respondent answered 'No' to all items indicating no conflicts; 1=Board member/owner/officer/committee appointments; 2=Medical/Orthopaedic Publications; 3=Royalties; 4=Speakers bureau/paid presentations; 5A=Paid consultant or employee; 5B=Unpaid consultant; 6=Research or institutional support from a publisher; 7=Research or institutional support from a company or supplier; 8=Stock or Stock Options; 9=Other financial/material support from a publisher; 10=Other financial/material support from a company or supplier).
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.