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Amputation Not Preferred for Bad Leg Injury

Study finds those with reconstructed limbs do just as well

WEDNESDAY, Dec. 11, 2002 (HealthDayNews) -- Amputation need no longer be the treatment of choice for a severe leg injury, says a study showing that patients who have surgical reconstruction do as well as those who get artificial legs.

That finding came as something of a surprise, says Dr. Alan L. Jones, an investigator in the study. "Although there were no data, we generally thought that reconstruction patients didn't do as well," says Jones, who is chief of trauma orthopedic surgery at the University of Maryland Shock Trauma Center. "But we did this study and found out they did about the same."

The study, which included 569 patients treated for severe leg injuries at eight major trauma centers, found that after two years, there was no significant difference in scores on the Sickness Impact Profile -- a measure of self-reported health status -- between amputees and those who retained their legs. Levels of disability and psychological distress and the percentage of patients who went back to work were also the same, says a report in tomorrow's issue of The New England Journal of Medicine.

"Prior to 1980, we would amputate most of these extremities, because we did not have the technology to do reconstruction," says Dr. Michael J. Bosse, an attending orthopedic trauma surgeon at the Carolinas Medical Center in Charlotte. "In the late 1970s and early 1980s, those technologies became common in leading trauma centers. But in the late 1980s, many surgeons began to question whether they had made the right decision, that perhaps the limits of the technology had been exceeded and it was not advisable to do reconstruction. That was the genesis of the study."

However, the study, which was coordinated by the Johns Hopkins Bloomberg School of Public Health, had one discouraging finding, Jones says: "No matter what the injury or the treatment, the patients did poorly in going back to work. Only half of them were working two years later, which is terrible."

Many factors that affected the ability to go back to work were not medical ones, the study found. Patients with strong support from family and friends did best. Those with poor education, low income and no health insurance did poorly. So did those who smoked and drank heavily, and members of minorities.

There are plans to do something about those factors, Jones says. "We want to do two things," he says. "We will have a second look at these same patients after five to seven years, to see how they are doing. Then we will design some interventions -- vocational counseling, social counseling -- to help them."

"We can affect their health habits, smoking and other habits that contribute to complications," Bosse says. "We can identify and treat psychological factors that impact the outcome. We certainly will look at vocational rehabilitation and training to affect the rate of return to work."

Such efforts will be worth the money spent on them, Jones says. A typical leg injury patient is a young manual laborer. Without rehabilitation and job training, he faces decades of joblessness. Plans are being made to seek funding for a rehabilitation study from the National Institutes of Health, Jones says.

What To Do

Information about amputation and rehabilitation can be found at the Methodist Health Care System. You can also try the Amputee Coalition of America.

SOURCES: Alan L. Jones, M.D., chief, trauma orthopedic surgery, University of Maryland Shock Trauma Center, Baltimore; Michael J. Bosse, attending orthopedic trauma surgeon, Carolinas Medical Center, Charlotte, N.C.; Dec. 12, 2002, The New England Journal of Medicine
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