# Characteristics of Traumatic Lower Extremity Amputation: Medical and Social Comorbidities

## TL;DR

This study finds that certain medical conditions and substance use increase the likelihood of traumatic lower extremity amputation, while traumatic brain injury may reduce it.

## Contribution

The study identifies medical comorbidities linked to traumatic amputation and explores their impact, even after excluding early amputations.

## Key findings

- Diabetes, hypertension, and chronic kidney disease are associated with increased traumatic amputation rates.
- Traumatic brain injury is significantly linked to reduced amputation likelihood.
- Alcohol and opioid use correlate with higher severity injuries and motor vehicle accident-related amputations.

## Abstract

Background

Traumatic amputations are life-altering injuries that remain prevalent despite the best efforts of physicians. While a multitude of research demonstrates various medical comorbidities that contribute to amputations, little attention has been paid to specific factors linked to traumatic amputation, even though trauma is the second most common etiology of amputation. The aim of this study was to determine whether any underlying medical conditions previously associated with non-traumatic amputation in the literature may also be associated with increased rates of amputation in cases of lower extremity trauma.

Methods

A retrospective database was constructed by accessing billing records at a level I trauma center in the United States between 2017 and 2022, identifying 63 cases of traumatic lower extremity amputation. A control group of 129 similar lower extremity fracture patients who did not undergo amputation was isolated from the same period using stratified sampling. The control group was matched to the amputation group in regard to age, sex, race, mechanism of injury, and whether the fracture created an open wound. Pearson chi-square statistical tests were performed to evaluate significant relationships at a 95% confidence interval.

Results

Patients with lower extremity trauma who presented with diabetes, hypertension, osteomyelitis, fasciotomy, alcohol intoxication, and chronic kidney disease were associated with increased rates of amputation. This correlation was preserved even after patients who underwent amputation within the first 48 hours of injury were excluded. Trauma patients who sustained traumatic brain injuries were significantly less likely to require amputation (p = 0.011). Among amputees, patients under the influence of alcohol, marijuana, or opioids/fentanyl were significantly more likely to sustain high-energy polytrauma and incur lower extremity trauma from motor vehicle accidents.

Conclusions

A multitude of medical comorbidities with causal links to chronic amputations were also associated with traumatic lower extremity amputations in this single-center case-control study. Patients who sustained traumatic brain injuries were less likely to require amputation, validating previous research linking head trauma to improved tissue healing or another protective mechanism. Alcohol intoxication was associated with increased rates of traumatic amputation, and associations were observed between substance use and higher severity injuries among amputees.