Short-term physical and mental health outcomes for combat amputee and nonamputee extremity injury patients

J Orthop Trauma. 2013 Feb;27(2):e31-7. doi: 10.1097/BOT.0b013e3182517e1c.


Objectives: The present study: (1) reports the early physical health complications, mental health outcomes, and outpatient health care utilization of patients with serious extremity injuries sustained during the Iraq or Afghanistan wars and (2) compares clinical outcomes between amputee and nonamputee extremity injury groups.

Method: This was a retrospective review of clinical records in military health databases for patients injured in the Iraq and Afghanistan wars. Health outcomes of amputee (n = 382, injured 2001-2005) and nonamputee patients (n = 274, injured 2001-2007) with serious extremity injuries (abbreviated injury score ≥ 3) were followed up to 24 months post injury. This study was performed at Naval Health Research Center, San Diego.

Results: Amputee and nonamputee groups had similar injury severity scores. Amputees had nearly double the risk of certain adverse complications (infections, anemia, septicemia, and thromboembolic disease), but other complications (osteomyelitis and nonhealing wound) were similar between the 2 groups. Amputees had significantly greater odds of certain mental health disorders including mood, sleep, pain, and postconcussion syndrome. However, amputees had significantly reduced odds of posttraumatic stress disorder compared with nonamputees. Amputees used various outpatient clinics significantly more than nonamputees.

Conclusions: Patients with serious combat extremity injuries showed high rates of adverse health outcomes in the short term. Amputees had higher rates of many but not all clinically important physical and mental health outcomes compared to nonamputees. These results are important for military orthopaedic surgeons and allied providers who care for and counsel these patients and clinicians and researchers who seek to understand and improve health outcomes in patients with extremity war injuries.

Level of evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Afghan Campaign 2001-
  • Amputees / psychology*
  • Extremities / injuries*
  • Female
  • Humans
  • Iraq War, 2003-2011
  • Male
  • Mental Disorders / etiology*
  • Middle Aged
  • Retrospective Studies
  • Wounds and Injuries / complications
  • Wounds and Injuries / psychology*
  • Young Adult