Late Sequelae of Amputation, a Summary

Late Sequelae of Amputation reports an extensive investigation of the late effects of amputation on the general health of the amputee. The subjects in the present series were Finnish war veterans disabled during the 1939-1945 wars and made available for the study while attending a government-sponsored three-week course of rehabilitation at the Kaskisaari Rehabilitation Center in Helsinki. The amputees participating in the study were chosen at random and considered to be representative of the average war disabled. Of the 311 subjects, 48 were upper-arm, 24 forearm, 65 thigh, and 157 lower-leg amputees; 17 were disabled men with two stumps, not identified as to limb. The average time elapsed since amputation was 18-1/2 years, and the average age of the amputee was 45 years. The control series consisted of 90 nonamputated persons who had fought during the wars and whose average age was also 45. The orthopaedic examination was given the amputee immediately upon his arrival at the Center, while the medical, radiological, and physiological examinations were carried out during the three-week period of the course. The team of investigators consisted of an orthopaedist, an internist, a radiologist, and a physiologist. Each specialist performed all the examinations in his particular field himself, thus ensuring evaluation of results on a uniform basis. A surprisingly large number of amputees, 62 per cent, were engaged in heavy or medium heavy labor. Two of the 17 persons with two amputated limbs had undertaken heavy labor. None was reported as unemployed. The general condition of the amputees was described as "very good" and of the same level as that of nonamputated persons in the control group. This observation was based on the state of nutrition, arterial pressure, the incidence of specific diseases, and the results of routine laboratory tests and miniature radiography of the chest. Also considered was the number of "healthy" persons in each group as determined by the absence of disease referable to internal medicine, mental disorder, and pathological radiographic or laboratory findings apart from the original injury. The only statistically significant difference in the series of examinations pertaining to general condition was reflected in the greater number of overweight persons among lowerlimb amputees as compared with the control group or with upper-limb amputees who had both legs intact. The authors attributed this finding to the limited mobility of the aboveknee amputee and proposed further pursuit of this study, taking into account the constitutional differences of individuals. The investigation showed that back pain constituted the most frequent complaint among amputees. Pain in the lumbar spine was reported by 65 per cent of the above-knee amputees; by 73 per cent of the below-knee amputees; and by 35 per cent of the control group, reflecting a highly significant difference between the lower-limb amputees and the control group. Pain in the cervical spine was noted by 8 per cent of both above-elbow and below-elbow amputee groups and by 1 per cent in the control group. Scoliosis of the thoracic spine must be considered a characteristic deformity in upperlimb amputees, based on the investigators' findings in which 92 per cent of the above-elbow amputees and 67 per cent of the belowelbow amputees presented this condition clinically. Radiologically, the frequency of