Direct Skeletal Fixation in bilateral above knee amputees following blast: 2 year follow up results from the initial cohort of UK service personnel. Issue 3 (March 2020)

• Record Type: Journal Article
• Authors: McMenemy, Louise; Ramasamy, Arul; Sherman, Kate; Mistlin, Alan; Phillip, Rhodri; Evriviades, Demetrius; Kendrew, Jon
• Is Part Of: Injury. Volume 51:Issue 3(2020)
• Page Start: 735
• Page End: 743
• Publication Date: 2020-03
• Subjects: Amputation -- Rehabilitation -- Osseointegration -- Direct Skeletal Fixation -- Military Trauma; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2020.01.006
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Direct Skeletal Fixation represents a safe procedure for blast injury patients in the presence of previous polymicrobial colonisation. Direct Skeletal Fixation improves quality of life outcomes and physical performance for bilateral above knee amputees following blast injury. Direct Skeletal Fixation requires life long follow up and potentially revision surgery. Abstract: Aims: The aim of the study is to evaluate the clinical outcome and complications from the initial cohort of blast injured bilateral lower limb, above knee amputees who underwent Direct Skeletal Fixation (DSF). Patients and methods: We undertook a retrospective analysis of a prospective data base identifying patients who had undergone implantation with the Australian Osseointegration Group of Australia-Osseointegration Prosthetic Limb (OGAP-OPL) prosthesis, with minimum 24 months follow up. Patient demographics, injury profile, and polymicrobial colonisation status were recorded. Physical functional performance measures recorded were the 6 minute Walk Test (6-MWT) and patient reported outcome measures were the Short Form Health Survey-36 (SF-36). Post operatively, complications including infection, re-operation, and fracture were recorded. Results: 7 patients (14 femora) were identified (mean age 29.8yrs), all injured by dismounted blast. Mean follow up was 46 months. All were polytrauma patients and all had previous polymicrobial colonisation. Following surgery, all patients mobilised with significant improvement in 6-minute walk time, with a mean improvement of 154 m (248 m vs 402 m, p = 0.018). The physical component score for the SF-36 demonstrated a statistically significant improvement from 34.65 to 54.5 ( p = 0.018) and the mental component score demonstrated a similar improvement (41.55–58.19 p = 0.018). At follow up, no patient required explantation of the implant. Each had been prescribed a minimum of 1 course of antibiotics with no evidence of deep infection. Conclusion: DSF is an option for amputees who, due to the nature of their injuries, may not be able to tolerate traditional suspension socket prostheses and have exhausted all other treatment options. At a minimum of 2 year follow up, the absence of significant infective complications suggests DSF may be utilised in the blast injured despite chronic polymicrobial colonisation. Longer term surveillance of these patients is required to assess the long-term suitability of this technique in this cohort of patients.