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Ten years at war: Comprehensive analysis of amputation trends

Krueger, Chad A. MD; Wenke, Joseph C. PhD; Ficke, James R. MD

Journal of Trauma and Acute Care Surgery: December 2012 - Volume 73 - Issue 6 - p S438–S444
doi: 10.1097/TA.0b013e318275469c

BACKGROUND While multiple studies have examined amputations that have occurred during the current conflicts in Iraq and Afghanistan, none of these studies have provided an overarching characterization of all of these injuries.

METHODS A retrospective study of all major extremity amputations sustained by US Service Members from January 2001 through July 30, 2011, was performed. Data obtained from these amputees included amputation level(s), mechanism of injury, time to amputation, Injury Severity Score (ISS), age, rank, number of trauma admissions, and number of troops deployed.

RESULTS There were 1,221 amputees who met inclusion criteria. These amputees sustained a total of 1,631 amputations. The number of amputations performed each year has increased dramatically in 2010 (196) and the first half of 2011 (160) from 2008 (105) and 2009 (94). The number of amputations performed per every 100 traumatic admissions (3.5–14) and the number of amputations per 100,000 deployed troops (2–14) has also increased in 2010 and the first half of 2011. Most amputations occurred at the transtibial (683, 41.8%) and transfemoral (564, 34.5%) levels. Thirty percent of the amputees (366) sustained multiple amputations, and 14% of all amputations (228) performed involved the upper extremity. There were 127 amputees (10%) who underwent their amputation more than 90 days after the date of injury.

CONCLUSION The number of amputations occurring during the current Iraqi and Afghanistan conflicts has increased in 2010 and the first half of 2011. Most amputations involve the lower extremities, and there is a much higher percentage of amputees who have sustained multiple amputations during current operations than previous conflicts.

LEVEL OF EVIDENCE Epidemiologic study, level IV.

Supplemental digital content is available in the article.

From the Brooke Army Medical Center (C.A.K., J.R.F.); US Army Institute of Surgical Research (J.C.W.), Fort Sam Houston, Texas.

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of the Army, Department of Defense, or the US government. This work was prepared as part of their official duties and, as such, there is no copyright to be transferred.

This study commenced after being approved by the US Army Institute of Surgical Research Institutional Review Board.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Address for reprints: Chad A. Krueger, MD, Orthopaedic Surgery, Brooke Army Medical Center, 3851 Roger Brooke Dr, Fort Sam Houston, TX 78234; email:

© 2012 Lippincott Williams & Wilkins, Inc.