Session I - Tibia Fractures

Bilateral Above Knee Amputees due to Battle Injuries Sustained inVietnam. Average 27.5 Year Follow-Up using the SF-36 Health Survey

Paul J. Dougherty, MAJ, MC, USA

William Beaumont Army Medical Center, El Paso, Texas, USA

Purpose: To ascertain the physical, social and work related limitations (functional outcome and health status) of patients who sustained bilateral above knee amputations (BAK) due to battlefield injuries.

Methods- Records of 484 battlefield amputees who were treated at an Army General Hospital (AGH) from 1967 to 1972 were reviewed. Of those patients, thirty (6.2%) were identified as having sustained bilateral above knee amputations. Data was collected and identified on mechanism of injury (land mine/booby trap, artillery, mortar, or small arms); other significant injuries, whether the patient was in shock on arrival at the initial surgical hospital in Vietnam, or whether they were successful prosthetic wearers at discharge from AGH. Three of twenty-nine (10%) have died since their release from the AGH. Twenty-three of twenty-seven (85.2%) had agreed to participate in a phone interview in which data on employment, marriage, prosthetics usage and psychological care, including participation in marriage counseling and alcoholics anonymous, were gathered. Age range at the time of follow up was 46-51 years (mean 47.9). The SF-36 health status questionnaire was also used to ascertain how patients compared to an age matched control population at an average of 27.5 years after injury. Mean scaled scores were calculated in each of the following areas: physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. Comparison of the scaled scores for each group was performed using a student's t-test (two tailed).

Results: Injuries were caused by land mines/booby traps (85.7%), artillery shells (9.5%) and small arms (4.7%). Bilateral above knee amputations were either due to trauma or as the initial surgical procedure in 90.5% of the patients. Additionally, three patients (13%) had upper extremity amputations: one above elbow, one below-elbow, and one wrist disarticulation. Fourteen patients (60%) were described as being in shock when arriving at the first hospital in Vietnam and received an average of 23.7 units of blood. Nineteen patients (82.6%) had employment outside the home since their discharge from AGH, in spite of rating significant disability compensation from the Veterans Administration. Twenty-one (91.3%) had been or are presently married, and twenty (87%) had children. One patient had post traumatic stress disorder and four patients had marriage counseling over the years. Three patients (14.2%) at the time of the study had significant prosthetic usage with an average of 7.6 hours/day. Six additional patients (26%) wore prostheses only when "going out." Results of the SF-36 health survey questionnaire showed an average score of 43.8 for physical function, 89.7 for role-physical, 77.5 for bodily pain, 70.6 for general health, 59 for vitality, 89.3 for social functioning, 98.8 for role emotional, and 82.5 for mental health. Only the physical function score was significantly less for the amputee group when compared to age matched controls (p<0.05).

Conclusion: Prior to this, no long term study on the functional outcome and health status of bilateral above knee amputees who were battle casualties from the Vietnam War exists. This group of patients has adapted well to their injuries and have led relatively normal and productive lives with regards to employment and social development, in spite of the tremendous challenges which are placed upon them. Although most had gained proficiency in walking while at AGH, nearly all now use a wheelchair as the main means of locomotion.