[Amputations. A five-year epidemiological study in Buenos Aires City]. / Sujetos con amputaciones en la Ciudad de Buenos Aires. Estudio epidemiológico de cinco años.

An amputation is the removal of a limb by surgery or accident. The aim of this paper was to carry out an epidemiological analysis on patients with amputations treated at the Instituto de Rehabilitación Psicofísica between 2009 and 2013. This is a retrospective, observational and cross-sectional study. The analyzed data included a total of 262 patients: 180 men (68.7%) and 82 women (31.3%). Our population mainly included subjects with only one amputated lower limb (83.6%), of vascular etiology (mostly diabetics) and with an average age of 63.5 years. The second sample group comprised traumatic amputees (29.8%), with an average age of 37 years and with a higher frequency of phantom pain. The characteristics of these groups can make them to behave differently during rehabilitation.

Use of prostheses in lower limb amputee patients due to peripheral arterial disease / Uso de próteses em amputados de membros inferiores por doença arterial periférica

Objective To evaluate the indication of prosthesis during rehabilitation and the maintenance of their use or abandonment rate after discharge, as well as mortality of lower limb amputees due to peripheral arterial disease. Methods A retrospective and cross-sectional study carried out with lower limb amputee patients, at transfemoral and transtibial levels, due to vascular conditions. The sample was composed of 310 patients (205 men, 105 women, mean age 61.8 years), transfemoral (142) and transtibial (150) levels, unilateral or bilateral (18). A total of 217 were fitted with prosthesis and 93 did not. Nonparametric statistical tests with equality of two proportions, 95% confidence interval and p value <0,05 were used. Results Out of 195 patients we contacted, 151 were fitted with prosthesis and 44 not. Of those that were fitted with prosthesis, 54 still use it, 80 abandoned and 17 died. In the group without prosthesis, 27 were on wheelchair and 17 died. Mortality is statistically higher among patients who were not fitted with prosthesis and 34 death occur, on average, 3.91 years after amputation. Survival time of patients who were not fitted with prosthesis was smaller than those were fitted. Conclusion The use of prosthesis in lower limb amputees, due to vascular conditions, during rehabilitation is high. However, maintenance of prosthesis is not frequent after discharge. Early and high mortality is observed mainly among diabetic patients. .

Objetivo Avaliar a protetização, durante a reabilitação, e a manutenção do uso da prótese, e o índice de abandono da mesma após a alta, bem como a mortalidade dos pacientes amputados de membros inferiores por doença arterial periférica. Métodos Estudo retrospectivo e transversal com pacientes amputados de membros inferiores nos níveis transtibial e transfemoral de etiologia vascular. A amostra foi composta por 310 pacientes (205 homens e 105 mulheres, média de idade de 61,8 anos), nos níveis transfemoral (142) e transtibial (150), unilateralmente ou bilateralmente (18). Foram protetizados 217 pacientes e 93 não. Foram utilizados testes estatísticos não paramétricos de igualdade de duas proporções, intervalo de confiança para média de 95% (IC95%) e valor de p<0,05 Resultados . Dos 195 pacientes contatados, 151 haviam sido protetizados e 44 não. Dos protetizados, 54 mantinham-se usando suas próteses, 80 haviam abandonado o uso e 17 faleceram. No grupo dos não protetizados, 27 continuavam usando cadeira de rodas e 17 tinham evoluído para óbito. A mortalidade é estatisticamente maior nos pacientes não protetizados e os 34 óbitos ocorreram, em média, após 3,91 anos da amputação. O tempo de sobrevida dos pacientes não protetizados foi menor que o dos protetizados. Conclusão A protetização de pacientes amputados de membros inferiores de etiologia vascular durante a reabilitação é alta, mas a manutenção do uso da prótese é baixa após o término do tratamento. A mortalidade desses pacientes é elevada e ...

Use of prostheses in lower limb amputee patients due to peripheral arterial disease.

OBJECTIVE: To evaluate the indication of prosthesis during rehabilitation and the maintenance of their use or abandonment rate after discharge, as well as mortality of lower limb amputees due to peripheral arterial disease. METHODS: A retrospective and cross-sectional study carried out with lower limb amputee patients, at transfemoral and transtibial levels, due to vascular conditions. The sample was composed of 310 patients (205 men, 105 women, mean age 61.8 years), transfemoral (142) and transtibial (150) levels, unilateral or bilateral (18). A total of 217 were fitted with prosthesis and 93 did not. Nonparametric statistical tests with equality of two proportions, 95% confidence interval and p value <0,05 were used. RESULTS: Out of 195 patients we contacted, 151 were fitted with prosthesis and 44 not. Of those that were fitted with prosthesis, 54 still use it, 80 abandoned and 17 died. In the group without prosthesis, 27 were on wheelchair and 17 died. Mortality is statistically higher among patients who were not fitted with prosthesis and 34 death occur, on average, 3.91 years after amputation. Survival time of patients who were not fitted with prosthesis was smaller than those were fitted. CONCLUSION: The use of prosthesis in lower limb amputees, due to vascular conditions, during rehabilitation is high. However, maintenance of prosthesis is not frequent after discharge. Early and high mortality is observed mainly among diabetic patients.

Perfil epidemiológico dos pacientes amputados de membros inferiores atendidos no Lar Escola São Francisco entre 2006 e 2012 / Epidemiological profile of lower limb amputees patients assisted at the Lar Escola São Francisco between 2006 and 2012

Objetivo: Analisar o perfil epidemiológico dos pacientes amputados de membros inferiores atendidos no Lar Escola São Francisco de 2006 a 2012. Método: A coleta de dados foi realizada de modo retrospectivo com 474 prontuários selecionados para verificar: gênero, idade, etnia, etiologia e nível de amputação, doenças associadas, intervalos de tempo entre a amputação e avaliação inicial e entre a avaliação inicial e a alta, presença de dor fantasma, uso de dispositivo auxiliar para marcha ou locomoção e independência em AVD. Os dados foram analisados descritivamente (porcentagem e média) e foi utilizado o teste do qui-quadrado, com p < 0,05, como teste de diferença de proporção para etnia e etiologia. Resultados: Trezentos e trinta e nove pacientes (72%) eram homens com média de idade de 56,2 anos; os níveis de amputação foram 43% transfemoral e 44% transtibial; a etiologia da amputação foi vascular em 341 pacientes (72%) sendo 73% em caucasianos; hipertensão arterial sistêmica e diabetes melitus foram as doenças associadas mais prevalentes; 267 pacientes (56%) foram protetizados, 100 pacientes (21%) abandonaram o tratamento. Conclusão: A população de amputados atendida no Lar Escola São Francisco no período estudado é composta, em sua maioria, por pacientes do gênero masculino, na quinta década da vida, com amputação de origem vascular nos níveis transfemoral e transtibial. Pouco mais da metade é protetizado, o índice de abandono do tratamento é elevado e o intervalo de tempo para reabilitação ainda é longo.

Objective: To analyze the epidemiology of lower limb amputees assisted at the Lar Escola São Francisco, between 2006 and 2012. Method: Samples were collected from medical records and found gender, age, ethnicity, etiology, amputation level, diseases, amputation and time between initial assessment, therapy time before and after fitting, time between baseline and discharge, use of assistive device and ADL. Data were analyzed descriptively and statistically and variables were presented by percentage and average. Results: 72% of the sample were male with a mean age of 56.2 years; 44% transfemoral and 43% transtibial; 72% of vascular origin with 73% caucasian. Conclusion: The population of amputees assisted at the Lar Escola São Francisco is composed mostly of male patients, between 50-60 years, with transfemural and transtibial vascular amputations. More than a half was fitted with a prosthesis, disregard index is high and time to rehabilitation is lengthy.

Necesidad de reamputación y características clínicas de los pacientes reamputados / Need for re-amputation and the clinical characteristics of re-amputated diabetic patients

Objetivo: determinar si existe asociación entre la necesidad de una reamputación y las características clínicas propias de los pacientes diabéticos reamputados.Métodos: se revisaron los 55 expedientes clínicos de los pacientes diabéticos que después de una amputación primaria necesitaron ser reamputados; se extrajeron los siguientes datos: edad, sexo, tipo y tiempo de evolución de la diabetes mellitus, tamaño y tiempo de evolución del área infectada. Para detectar las posibles asociaciones de estas variables con la necesidad de reamputación se aplicó la prueba de ji-cuadrada. Resultados: se encontró que 26 (47,2 por ciento) pacientes reamputados estaban dentro del grupo de edades entre 60-69 años, 33 (60 por ciento) eran del sexo femenino; 52 (94,6 por ciento) eran diabéticos tipo 2, y 40, más del 70 por ciento tenían más de 20 años de evolución de la enfermedad. Se constató que 49 (89,1 por ciento) pacientes presentaron infección, con un tamaño del área infectada hasta de 20 cm2 en el 85,4 por ciento de ellos; con una evolución en 21 (38,1 por ciento) de hasta 30 días y en 31(56,3 por ciento),entre uno y seis meses. Se hallaron resultados estadísticamente significativos entre la necesidad de reamputación con el grupo de edad (p= 0,006); el tiempo de evolución de la diabetes (p= 0,00) y el tamaño del área de infección (p= 0,024).Conclusiones: la edad, el tiempo de evolución de la diabetes y el tamaño del área de infección son las características que se asocian con la necesidad de reamputación en los pacientes diabéticos(AU)

Objective: to determine whether there is association between the need for re-amputation and the clinical characteristics of the re-amputated diabetic patients. Methods: fifty five medical histories of those diabetic patients who were re-amputated were reviewed to obtain the following information: age, sex, type and time of evolution of diabetes mellitus, size and time of evolution of the infected area. The variables were correlated with the need for re-amputation. Results: it was found that 26 (47.2 percent) of the re-amputated patients were included in the 60-69 y age group; 33 (60 percent)were females; 52 (94.6 percent) had diabetes mellitus type 2 and 40(over 70 percent) had suffered diabetes mellitus for more than 20 years. It was stated that 49 (89.1 percent) of the patients presented infection, with the infected area size up to 20 cm2 in 85.4 percent; and the infection evolution was within 30 days in 21 (38.1 percent) patients and one to six months in 31 (56.3 percent). There was significant association among the need for re-amputation and the age groups (p= 0.006); the time of evolution of diabetes mellitus (p= 0.00) and the area of infection size (p= 0.024). Conclusions: age, the time of evolution of diabetes and the area of infection size are the characteristics associated with the need for re-amputation in the above mentioned patients(AU)

Life after lower extremity amputation in diabetics / La vida tras la amputación de las extremidades inferiores por diabetes

Lower limb amputees typically have reduced mobility which affects their ability to perform daily tasks and to successfully reintegrate into community life. A major goal of rehabilitation for amputees is to improve quality of life (QOL). This study therefore focussed on QOL and functional independence for persons with lower limb amputations secondary to diabetes. OBJECTIVE: To determine the QOL and functional independence of lower limb diabetic amputees one to three years post amputation, using variables such as age, gender and amputation level. METHOD: A total of 87 participants were selected from the 2006-2009 physiotherapy records at the St Ann's Bay Hospital. These participants completed the World Health Organization Quality of Life Scale (WHO QOL-BREF) and the Functional Independence Measure (FIM). Data were analysed using SPSS (version 12) and the mean values for QOL and functional independence were calculated. Relationships between the variables: age, gender and level of amputation with QOL and functional independence were analysed using descriptive and inferential statistical techniques. RESULTS: Among the 35 males and 52 females participating in the study, below knee amputees recorded higher scores for QOL (p < 0.05) and functional independence (p < 0.0001) compared to the above knee amputees. The result also showed that females had a significantly higher average score than males among the four domains for QOL. Similar results were obtained from the FIM where women again had significantly higher scores than males (p < 0.0001). The majority of females across the age groups reported average to high QOL (p < 0.0001) compared to the males. A positive correlation (r = 0.5999, p < 0.0001) was found between functional independence and quality of life of all participants. CONCLUSION: The results showed that below knee amputees functioned better than those with above knee amputations and that females were more likely to cope and function with the disability than males.

Los amputados de las extremidades inferiores enfrentan el cuadro típico de la reducción de su movilidad, lo cual afecta su capacidad para realizar las tareas cotidianas y reintegrarse con éxito a la vida de la comunidad. Uno de los objetivos principales de la rehabilitación de los amputados es mejorar la calidad de vida (CDV). En concordancia con ello, este estudio centra su atención en la CDV y la independencia funcional de personas con amputación de las extremidades inferiores a consecuencia de diabetes secundaria. OBJETIVO: Determinar la CDV y la independencia funcional de diabéticos amputados de las extremidades inferiores, de uno a tres años tras la amputación, a partir de variables tales como la edad, el género, y el nivel de amputación. MÉTODO: Un total de 87 participantes fueron seleccionados de los archivos de fisioterapia de 2006- 2009 en el Hospital Saint Ann Bay. Estos participantes completaron las evaluaciones de la Escala de Calidad de Vida de la Organización Mundial de la Salud (WHO QOL-BREF) y la Medida de Independencia Funcional (MIF). Se analizaron los datos usando SPSS (versión 12) y se calcularon los valores promedios de la CDV y la independencia funcional. Las relaciones entre las variables - edad, género y nivel de amputación - con respecto a la CDV y la independencia funcional, fueron analizadas usando técnicas estadísticas descriptivas e inferenciales. RESULTADOS: Entre los 35 varones y 52 hembras que participaron en el estudio, los amputados por debajo de la rodilla registraron puntuaciones más altas para la CDV (p < 0.05) y la independencia funcional (p < 0.0001) en comparación con los amputados por arriba de la rodilla. El resultado también mostró una puntuación promedio significativamente más alta en las hembras que en los varones, en los cuatro dominios de la CDV. Se obtuvieron resultados similares del MIF, en los que de nuevo las mujeres tenían puntuaciones significativamente más altas que los varones (p < 0.0001). La mayoría de las hembras en todos los grupos etarios reportaron desde una CDV promedio a una CDV alta (p < 0.0001) en comparación con los varones. Se halló una correlación positiva (r = 0.5999, p < 0.0001) entre la independencia funcional y la calidad de vida de todos los participantes. CONCLUSIÓN: Los resultados mostraron que los amputados por debajo de las rodillas funcionaban mejor que aquéllos con amputaciones por encima de la rodilla, y que las mujeres presentaban una mayor probabilidad de lidiar y funcionar exitosamente con la discapacidad en comparación con los hombres.

Life after lower extremity amputation in diabetics.

UNLABELLED: Lower limb amputees typically have reduced mobility which affects their ability to perform daily tasks and to successfully reintegrate into community life. A major goal of rehabilitation for amputees is to improve quality of life (QOL). This study therefore focussed on QOL and functional independence for persons with lower limb amputations secondary to diabetes. OBJECTIVE: To determine the QOL and functional independence of lower limb diabetic amputees one to three years post amputation, using variables such as age, gender and amputation level. METHOD: A total of 87 participants were selected from the 2006-2009 physiotherapy records at the St Ann's Bay Hospital. These participants completed the World Health Organization Quality of Life Scale (WHO QOL-BREF) and the Functional Independence Measure (FIM). Data were analysed using SPSS (version 12) and the mean values for QOL and functional independence were calculated. Relationships between the variables: age, gender and level of amputation with QOL and functional independence were analysed using descriptive and inferential statistical techniques. RESULTS: Among the 35 males and 52 females participating in the study, below knee amputees recorded higher scores for QOL (p < 0.05) and functional independence (p < 0.0001) compared to the above knee amputees. The result also showed that females had a significantly higher average score than males among the four domains for QOL. Similar results were obtained from the FIM where women again had significantly higher scores than males (p < 0.0001). The majority of females across the age groups reported average to high QOL (p < 0.0001) compared to the males. A positive correlation (r = 0.5999, p < 0.0001) was found between functional independence and quality of life of all participants. CONCLUSION: The results showed that below knee amputees functioned better than those with above knee amputations and that females were more likely to cope and function with the disability than males.

A descriptive study of traumatic lower limb amputees from the Hospital Hel Trabajador: clinical evolution from the accident until rehabilitation discharge.

The purpose of the study was to describe the demographics, the causes of amputations, the amputation levels, the clinical outcomes, the durability of prostheses in unilateral lower limb amputee among workers entitled to non-state related work insurance, the ACHS, Chile, between 1974 and 2001. It was a retrospective descriptive study based on selected clinical files. One hundred files, with the minimal data required, were selected with a diagnosis of traumatic lower limb amputation, the levels ranging from Boyd's foot amputation to hip disarticulation, as defined by the Occupational Accidents Act from 1974 to December 2001. The mean age was 35.5 years, 96% were males, with an average follow-up of 7.7 years. In 50% of the cases the education level did not exceed elementary school. Ninety-eight percent were blue collar workers. The traumatic injury resulting in amputation took place during work in 89% of the cases the main causes being crushing injury (50%), traffic accident (19%), run over by car (14%) and burns (6%). The most common amputation levels were trans-femoral (40%) and trans-tibial (47%). Amputations were performed within the first 24 h in 49% of the cases. The hospitalization stay reached 8 weeks in 56.7%. Early complications were dehiscence (9.4%), superficial infection, (14.6%) and deep infection (26%). Late complications detected were soft tissue lesions (34.1%), exostosis (3.6%), painful neuroma (12.5%) and phantom limb pain (12.5%). Prostheses durability was on average 3 years. The average period to resume work was 1 year for 60% of the cases.

A picture of amputees and the prosthetic situation in Haiti.

PURPOSE: The purpose of this study is to present the situation of Haitian amputees and to outline some of the major barriers in Haiti that prevent people from receiving prosthetic treatment. METHOD: Interviews were conducted with amputees throughout Haiti using a 42-question questionnaire. Additionally, interviews were conducted with traditional healers, health care workers, and leaders of handicap associations. Each interview was manuscripted and the data were subsequently coded and analysed in the USA. RESULTS: There are three full-time prosthetic shops and two part-time prosthetic shops in Haiti, all of which are severely limited in the scope of services they are able to provide amputees due to insufficient supplies and inadequately trained personnel. Only 25% of the 164 amputees interviewed had ever had a prosthetic limb. Typically prosthetic treatment is inaccessible and unaffordable for amputees, which prevents many from seeking treatment. The most common cause of amputation in Haiti is infection, followed by motor vehicle accidents. CONCLUSION: There must be additional cooperation between Haitian patients, doctors, traditional healers, prosthetists, and government officials in order to provide more adequate prosthetic care. Prosthetic treatment in Haiti can be successful with cooperation of different entities, proper rehabilitation therapy, adequately trained personnel, and development of culturally appropriate limbs.

Contribuição do diabetes mellitus nas amputações de membros inferiores ( A)

Trata-se de um estudo descritivo retrospectivo que teve com o objetivo analisar a contribuição do Diabetes Mellitus nas amputações em membros inferiores. As variáveis analisadasforam: demográficas e estilo de vida; caracterizando as amputações segundo as causas e faixa etária, níveis, número e lado da amputação, úlcera prévia à amputações, presença de infecções nasúlceras e coto e tempo de hospitalização entre as pessoas com e sem DM, mortalidade intra hospitalar ocorridas entre as pessoas com diabetes mellitus, identificar as pessoas com D Msubmetidas a amputações o tempo do diagnóstico, tratamento, presença de complicações crônicas e doenças associadas....