US Department of Defense
BLAST INJURY RESEARCH
COORDINATING OFFICE
Advancing Blast Injury Research to Protect and Heal Those Who Serve

Amputation or Surgical Reconstruction?


Intrepid Dynamic Exoskeletal Orthosis (IDEO)
Figure caption: Intrepid Dynamic Exoskeletal Orthosis (IDEO)

Extremity trauma injuries are often experienced during blast exposure and can result in one or more amputations. In recent years, surgical advances have substantially improved outcomes for individuals sustaining traumatic lower extremity injury with injuries that once required lower limb amputation now being routinely managed with limb reconstruction surgery. Although these advances have provided wounded Service members and their clinical teams with new treatment options, comparisons of long term functional outcomes between the procedures are inconclusive.

To directly address functional outcomes, researchers from the Center for the Intrepid at Brooke Army Medical Center conducted a study to compare lower extremity biomechanics during walking in 72 individuals with either lower limb reconstruction, transtibial amputation, or no injuries (able-bodied controls). All participants with lower limb reconstruction used the Intrepid Dynamic Exoskeletal Orthosis (IDEO) ankle-foot orthosis while participants with transtibial amputation used a variety of passive, dynamic-response prosthetic feet.

Results from the study demonstrate that individuals with lower limb amputation or reconstruction can achieve many aspects of normative gait biomechanics and self-selected walking speeds equivalent to those in able-bodied individuals. The gait deviations that were present were most apparent in the knee in individuals with transtibial amputation and at the ankle in patients with lower limb reconstruction wearing the semi-rigid IDEO. The clinical decision leading to amputation or lower limb reconstruction is complex and multifactorial. Although alterations in gait biomechanics resulting from amputation or reconstruction may not directly impact the clinical decision making process, the more comprehensive understanding of outcomes associated with each procedure provided by this research will aid clinicians in counseling patients on expected outcomes following either procedure.

The views expressed herein are those of the authors and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army or the Department of Defense or the U.S. Government.

Publications:

Russell Esposito, E, Stinner, DJ, Fergason, JR, Wilken JM. (2017). Gait biomechanics following lower extremity trauma: Amputation vs. reconstruction. Gait Posture. 54: 167-173. doi: 10.1016/j.gaitpost.2017.02.016.

Last modified: 26-Oct-2017