The causes and levels of lower limb amputation in geriatricpatients

Aim: Lower limb amputations (LLA) are considered as a serious psychosocial condition. The causes of amputation in young personsare generally trauma, work accidents, or tumors, while in geriatric patients, it is mostly vascular problems. The aim of this study is todetermine the causes and levels of LLA of geriatric patients in a tertiary care center.Materials and Methods: In order to conduct this study, information was obtained from the automation records of geriatric patientswho underwent LLA in our clinic between the years 2014 and 2017. We divided our patients into three groups according to their ages. Group 1 consisted of those patients in the age group of 65-74 years, Group 2: 75-84 years, and Group 3: 84-95 years. We also classified our patients according to amputation causes and levels.We classified the patients as above-knee, transtibial, metatarsal, and toe amputation according to the level of lower extremity amputation.Results: Of the 96 patients included in the study, 70 were male (72.9%), and 26 (27.1%) were female. Group 1 consisted of 45 patients,group 2had 38 patients, and group 3 had 13 patients. It was observed that the most common cause of LLA was diabetic foot ulcers (65 patients), followed by ischemic foot as a cause of LLA in 25 patients. Moreover,4 patients were amputated due to a tumor, while amputation was performed in 2 patients as a result of a crush injury. It was observed that metatarsal and toe amputation was the most common amputation type according to amputation levels. (26 patients)Conclusion: As a result of our study, the most common cause of LLA in Geriatric patients was diabetic foot ulcers. Considering thatlower extremity amputations cause severe morbidity and mortality in geriatric patients, it is crucial to identify these patients with preventive medicine practices.

PDF

___

1. Wald J, Alvaro R. Psychological factors in work- related amputation: considerations for rehabilitation
counselors. J Rehabil 2004;70:6-15.
2. Rybarczyk B, Edwards R, Behel J. Diversity in
adjustment to a leg amputation:case illustrations of
common themes. Disabil Rehabil 2004;26:944-53.
3. Dillingham TR, Pezzin LE, Mackenzie EJ. Racial
differences in the incidence of limb loss secondary
to peripheral vascular disease: a population-based
study. Arch Phys Med Rehabil 2002;83:1252-7.
4. Perkins ZB, Yet B, Glasgow S, et al. Meta-analysis of
prognostic factors for amputation following surgical
repair of lower extremity vascular trauma. Br J Surg
2015;102:436-50.
5. Stern JR, Wong CK, Yerovinkina M, et al. A meta-
analysis of long-term mortality and associated risk
factors following lower extremity amputation. Ann
Vasc Surg 2017;42:322-7.
6. Moxey PW, Gogalniceanu P, Hinchliffe RJ, et al. Lower extremity amputations – a review of global variability
in incidence. Diabet Med 2011;28:1144-53.
7. vanNetten JJ, Fortington LV, Hinchliffe RJ, et al.
Early post-operative mortality after major lower limb
amputation: a systematic review of population and
regional based studies. Eur J Vasc Endovasc Surg
2016;51:248-57.
8. Davie-Smith F, Paul L, Nicholls N, et al. The impact of
gender, level of amputation and diabetes on prosthetic
fit rates following major lower extremity amputation.
Prosthet OrthotInt 2017;41:19-25.
9. Horgan O, MacLachlan M. Psychosocial adjustment
to lower-limb amputation: a review. Disabil Rehabil
2004;26:837-50.
10. Unwin N. Epidemiology of lower extremity amputation
in centres in Europe,North America and East Asia. Br J
Surg 2000;87:328-37.
11. Moxey PW, Gogalniceanu P, Hinchliffe RJ, et al. Lower
extremity amputations--a review of global variability
in incidence. Diabet Med 2011;28:1144-53.
12. Lazlo G, Belicza E, KullmannL .Lower limb amputations
during 3 years in Hungary. Arch Orthop Trauma Surg
1999;119:94-7
13. Gailey R, Allen K, Castles J, et al. Review of secondary
physical conditions associated with lower-limb
amputation and long-term prosthesis use. J Rehabil
Res Dev 2008;45;15-30.
14. Ephraim PL, Dillingham TR, Sector M, et al. Epidemiology of limb loss and congenital limb
deficiency: a review of the literature. Arch Phys Med
Rehabil 2003;84:747-61.
15. Chen SY, Chie WC, Lan C, et al. Rates and
characteristics of lower limb amputations in Taiwan,
1997.ProsthetOrthotInt 2002;26:7-14
16. Esquenazi A. Geratric amputee rehabilitation.
ClinGeriatr Med 1993;9:731-43.
17. Boulton AJ. The diabetic foot: a global view. Diabetes
Metab Res Rev 2000;16:2-5
18. Armstrong DG, Boulton AJM, Bus SA. Diabetic
Foot Ulcers and Their Recurrence. N Engl J Med
2017;376:2367-75.
19. Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, et al.
The global burden of diabetic foot disease. Lancet
(London, England) 2005;366:1719-24.
20. Varma P, Stineman MG, Dillingham TR. Epidemiology
of limb loss. Phys Med RehabilClin N Am 2014;25:1-8.
21. Nagarajan R, Neglia JP, Clohisy DR, et all. Limb
salvage and amputation in survivors of pediatric
lower-extremity bone tumors: what are the long-term
implications? J ClinOncol 2002;20:4493-501.
22. Gormeli G, Gormeli CA, Karakaplan M, et all . The
Amputation Indicated Extremity Can Be Recovered
by Multidisciplinary Treatment: A Case Report and
Review of Literature. Medicine Science 2015;4:2281-8.