# Acute Complications of United States Service Members with Combat-Related Lower Extremity Limb Salvage

## TL;DR

This study analyzed acute complications in U.S. Service members with combat-related lower limb injuries, comparing outcomes for amputation, limb salvage, and non-threatening trauma.

## Contribution

The study provides new insights into complication rates among different treatment groups for combat-related limb injuries in Service members.

## Key findings

- Primary amputation (PA) had higher complication rates than limb salvage (LS) and non-threatening trauma (NTLT), except for non-union fractures.
- The LS group with secondary amputation (LS-SA) had higher complication rates than those without (LS-NA).
- PA was most associated with post-hemorrhagic anemia and heterotopic ossification, while LS-SA was linked to osteomyelitis and non-healing wounds.

## Abstract

Background: This study examined the incidence of acute complications within the first year following combat-related lower extremity injuries in United States (U.S.) Service members (SMs). The research compared outcomes between primary amputation (PA), limb salvage (LS), and non-threatening limb trauma (NTLT) groups, and conducted a subgroup analysis within the LS group, differentiating between SM who underwent a secondary amputation (LS-SA) and those who did not (LS-NA). Methods: A retrospective analysis of combat-related lower extremity injuries sustained between January 2001 and October 2015 was performed using data from the Military Health System Medical Data Repository. Chi-square tests and adjusted logistic regression analysis were used to compare complication frequencies by injury severity. Results: The analysis of the 4275 SM revealed that 21% had undergone PA, 47% LS (with 13% experiencing LS-SA and 87% LS-NA), and NTLT was observed in 32% of cases. The PA group exhibited higher rates of most acute complications compared to other groups, with three exceptions—i.e., non-union fractures, compartment syndrome, and orthopedic device complications were more prevalent in the LS group than the PA group. The LS-SA group had higher complication rates than the LS-NA group for most complications. Notably, the PA group was associated with the highest rates of post-hemorrhagic anemia and heterotopic ossification, while the LS-SA group exhibited the highest rates of osteomyelitis, non-union fractures, non-healing wounds, and compartment syndrome. Conclusions: Individuals with amputation (PA or LS-SA) were more likely to experience acute complications compared to their counterparts (PA vs. LS and NTLT; LS-SA vs. LS-NA), with the exception of non-union fractures, which were more frequent in the LS group than the PA group. These findings highlight the need for close monitoring and targeted interventions to address post-surgical complications in Service members with limb salvage.