Unilateral lower limb loss following combat injury

Medium-term outcomes in British military amputees

P. M. Bennett, I. D. Sargeant, M. J. Midwinter, J. G. Penn-Barwell


This is a case series of prospectively gathered data characterising the injuries, surgical treatment and outcomes of consecutive British service personnel who underwent a unilateral lower limb amputation following combat injury. Patients with primary, unilateral loss of the lower limb sustained between March 2004 and March 2010 were identified from the United Kingdom Military Trauma Registry. Patients were asked to complete a Short-Form (SF)-36 questionnaire. A total of 48 patients were identified: 21 had a trans-tibial amputation, nine had a knee disarticulation and 18 had an amputation at the trans-femoral level. The median New Injury Severity Score was 24 (mean 27.4 (9 to 75)) and the median number of procedures per residual limb was 4 (mean 5 (2 to 11)). Minimum two-year SF-36 scores were completed by 39 patients (81%) at a mean follow-up of 40 months (25 to 75). The physical component of the SF-36 varied significantly between different levels of amputation (p = 0.01). Mental component scores did not vary between amputation levels (p = 0.114). Pain (p = 0.332), use of prosthesis (p = 0.503), rate of re-admission (p = 0.228) and mobility (p = 0.087) did not vary between amputation levels.

These findings illustrate the significant impact of these injuries and the considerable surgical burden associated with their treatment. Quality of life is improved with a longer residual limb, and these results support surgical attempts to maximise residual limb length.

Cite this article: Bone Joint J 2013;95-B:224–9.


  • On behalf of the Severe Lower Extremity Combat Trauma (SeLECT) Study Group: Surg Lt Cdr J. G. Penn-Barwell, Surg Lt P. M. Bennett, Surg Lt Cdr C. A. Fries, Wg Cdr J. M. Kendrew, Surg Capt M. Midwinter, Surg Cdr R. F Rickard, Gp Capt I. D. Sargeant, Professor K. Porter, Lt Col T. Rowlands, Lt Col A. Mountain, Lt Col T. Cubison, Mr J. Cooper, Mr D. Wallace, Mr D. Power, Lt Col S. Jeffery, Wg Cdr D. Evriviades, Wg Cdr W. J. C. van Niekerk, Col A. Kay L/RAMC, SRMRC/RCDM/Queen Elizabeth Hospital, Birmingham, United Kingdom.

    The authors would like to thank Mrs J. Beach for helping to collect and analyse the study results and Mr S. Banwell for assisting in data collection. The Academic Department of Military Emergency Medicine (ADMEM), Defence Analytical Services and Advice (DASA) are thanked for collecting, collating and identifying the appropriate data for this paper. The authors would also like to thank Professor N. Gunawardena MD, University of Colombo, Sri Lanka, Dr H. Taghipour MD and Dr Y. Moharamzad MD, Baqiyatallah Medical Sciences Centre, Iran, for generously sharing unpublished data from their previous work in this field.

    The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Ministry of Defence or Her Majesty’s Government.

    All of the authors are serving officers in the Royal Navy and Royal Air Force and the copyright of this work remains with the crown.

    No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

  • Received July 4, 2012.
  • Accepted October 31, 2012.
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