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Webinar Description
Background:
In modern conflicts, extremities are mainly affected, with limb amputations required for approximately 5% of severely injured combatants and 7% of those with serious limb injuries. Amputations are some of the most challenging injuries endured by survivors, significantly affecting the patients and the healthcare system. This study aims to describe the rates, characteristics, and risk factors of limb amputations in patients with serious extremity trauma during the 2023 conflict in Israel.
Methods:
This nationwide retrospective cohort study, based on the Israel National Trauma Registry, includes all patients with serious extremity injuries (abbreviated injury score ≥3) from October 7 to December 31, 2023. Demographic and clinical characteristics, as well as outcomes of patients with limb amputations were compared with those who were not amputated. Multivariable logistic regression was used to identify risk factors for amputations.
Results:
Among the 1,815 combat-related casualties, 1,318 (72.6%) sustained extremity injuries, and 451 (24.8%) had serious limb injuries. Most patients with severe limb injuries were young males, with 287 of 451 being soldiers. 150 of 451 were injured by explosions, and 158 of 451 had severe and critical injuries (ISS ≥16). Of 451 patients, 52 (11.5%) underwent limb amputations (43 lower limbs, eight upper limbs, and one both). Amputees were significantly more likely to be injured by explosions (76.9% vs. 27.6%, P < 0.001), have an ISS of ≥16 (75.0% vs. 29.8%, P < 0.001), and have polytrauma (46.1% vs. 27.1%, P = 0.004). Independent risk factors for amputation included explosions (adjusted odds ratio [aOR] 9.74, 95% confidence interval [CI] 4.83 to 21.32, P < 0.001), fasciotomy (aOR 8.51, 95% CI 2.82 to 25.74, P < 0.001), and polytrauma (aOR 1.98, 95% CI 1.03 to 3.78, P = 0.04). Vascular injuries were not associated with amputations (aOR 0.87, 95% CI 0.39 to 1.85, P = 0.72).
Conclusions:
In recent conflicts, amputation rates have risen, likely due to increased tissue destruction from modern weaponry and improved survival rates among severely injured patients. Those with multiple severe injuries, blast injuries, or requiring fasciotomies face a higher risk of amputation.
Learning Objectives
- Describe the incidence and epidemiology of limb amputations among patients with serious extremity trauma in modern warfare settings.
- Identify independent risk factors for limb amputation, including blast injuries, polytrauma, high injury severity scores (ISS ≥16), and the need for fasciotomy.
- Interpret multivariable risk data to stratify amputation risk in patients presenting with severe extremity trauma.
- Apply evidence-based insights from contemporary combat trauma to improve early recognition, surgical decision-making, and multidisciplinary management strategies aimed at limb salvage when feasible.
Co-Directors
Phillip Mitchell, MD, MSc, FAAOS, Daniel Stinner, MD, PhD, FAAOS, FACS
Article Co-Authors:
Shachar Shapira, MD, Sharon Goldman, MPH, Adi Givon, BSc, Eldad Katorza, MD, Israel Dudkiewicz, MD, MHA, Danny Epstein, MD, Daniel Prat, MD
The American Academy of Orthopaedic Surgeons is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education (CME) for physicians. The American Academy of Orthopaedic Surgeons designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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