Outcomes of amputation and limb salvage in combat injuries: Does level of injury matter? A secondary analysis of Military Extremity Trauma Amputation/Limb Salvage (METALS) study data
Abstract
BACKGROUND
The Lower Extremity Assessment Project (LEAP) and Military Extremity Trauma Amputation/Limb Salvage Study (METALS) reported conflicting results with respect to severe lower extremity injuries treated with limb salvage versus amputation. The LEAP study reported no difference between amputation and limb salvage groups, while the METALS study reported improved outcomes with amputation. The purpose of this study was to re-evaluate the METALS data to determine whether the ankle/hindfoot injuries were the main driver of the results of improved outcome with amputation.
METHODS
This is a retrospective secondary analysis of METALS data including military personnel deployed to Afghanistan or Iraq between 2003 and 2007 with severe lower extremity combat injuries. METALS patients with a unilateral transtibial amputation, or unilateral limb salvage of a qualifying injury distal to the femoral condyles were included. Amputation patients were compared to two separate limb salvage groups: severe ankle/hindfoot injuries (ie. ankle/hindfoot salvage group) versus mid/proximal tibia injuries (ie proximal limb salvage group). Short Musculoskeletal Function Assessment (SMFA) scores were compared between groups. Multivariable regression models compared outcomes across treatment groups, adjusting for age, race/ethnicity, time from injury, combat experience, and social support.
RESULTS
161 patients were included: 60 amputation, 41 ankle/hindfoot salvage, 62 proximal limb salvage.…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 161 participants or records.
Read the paper
Related studies
- Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials
- Tocilizumab in patients with severe COVID-19: a retrospective cohort study
- A new aging measure captures morbidity and mortality risk across diverse subpopulations from NHANES IV: A cohort study
- Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): a prospective cohort study
- Are noise and air pollution related to the incidence of dementia? A cohort study in London, England
- Long COVID symptoms and duration in SARS-CoV-2 positive children — a nationwide cohort study
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.