When it comes to severe, limb-threatening injuries, the adage "time heals all wounds" doesn't necessarily apply. In a follow-up study of people who had undergone either leg amputation or reconstruction an average of 84 months earlier, researchers found their physical and psychological outcomes were actually worse than they had been at the two-year mark.

To determine whether people who underwent leg reconstruction fared similarly in the long term to those who had undergone amputation, researchers supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases re-interviewed 397 participants of the 2003 LEAP (Lower Extremity Assessment Project) study. LEAP was a prospective study of 601 patients from eight level-1 trauma centers to evaluate the impact of severe lower extremity injuries.

While the follow-up study found that functional outcomes were comparable for those undergoing amputation or reconstruction, the results with either treatment were less favorable than the researchers had anticipated. Just over one-third of those interviewed had functional scores (based on various assessments of physical and psychological functioning) comparable to the general population; one-half had scores indicative of substantial disability.

Patient characteristics that were significantly associated with poorer outcomes included older age, being female, nonwhite race, lower education level, living in a poor household, current or previous smoking, low self-efficacy (belief that one can control his or her own outcome), poor self-reported health status before the injury and involvement with the legal system in an effort to obtain disability payments. Men who were younger at the time of injury and those with a higher socioeconomic status had the best outcomes.

The study's results confirm previous conclusions that reconstruction for the treatment for injuries below the knee typically results in functional outcomes equivalent to those of amputation, says Ellen J. MacKenzie, Ph.D., professor and the director of the Center for Injury Research and Policy at Johns Hopkins Bloomberg School of Public Health and the study's lead author. Regardless of the treatment option, however, long-term functional outcomes are poor, she says. Priority should be given to efforts to improve post-acute-care services that address secondary conditions that compromise optimal recovery.

The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the Department of Health and Human Services' National Institutes of Health, is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. For more information about NIAMS, call the information clearinghouse at (301) 495-4484 or (877) 22-NIAMS (free call) or visit the NIAMS Web site at http://www.niams.nih.gov.

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MacKenzie EJ, et al. Long-term persistence of disability following severe lower limb trauma, JBJS 2005:87-A(8):1801-1809.

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