The Northern Ireland troubles and limb loss: a retrospective study

Successful management of femoral trauma in a through-knee amputee with a previous malunited fracture: Implications and functional outcome

BACKGROUND

After amputation patients are more likely to injure their residual limb. An injury of a previously amputated limb, especially if the residuum is not anatomically normal, poses a dilemma for management. Case Description and Methods: This case report discusses a femoral fracture sustained proximal to a through-knee amputation. Findings and outcomes: The fracture was at the site of a malunited fracture. A shortening osteotomy with bone graft was undertaken to improve alignment and prosthetic fit and remove poor-quality bone. This was stabilised using an intramedullary nail, supplemented with an anti-rotation plate. This fracture went on to uneventful union, and the patient was able to comfortably use a prosthesis with increased functionality compared with prior to the recent injury.

DISCUSSION

This management enabled quick healing of the fracture without the need to resort to a more proximal amputation.

CONCLUSION

In these unusual cases, careful planning is necessary to ensure all aspects of the problem is dealt with. Each case should be treated on its own merits. Clinical relevance This case demonstrates the difficulty in care of complex limb trauma and offers a solution for management of similar cases. Excellent results are possible when all surgical options are considered.

Injured and disabled casualties of the Northern Ireland conflict: issues in immediate and long-term treatment, care and support

Even though injury due to armed conflict is more commonly caused than death, research into injury due to Northern Ireland's four decades of otherwise exhaustively documented conflict is sparse. This article reports on a 2011 study based on interviews with 30 people seriously physically injured in the conflict and 20 of their carers and a self-administered questionnaire survey of a further 90 people injured in political violence in Northern Ireland. All injured respondents reported that emergency medical emergency treatment had been excellent. Those injured in the 1970s reported low expectations of their life expectancy and rehabilitation, a lack of psychological support and lack of help with chronic injury-related conditions. More recently injured people had psychological support and were more successfully rehabilitated but those injured earlier often saw it as 'too late' for psychological help. Influences on well-being seem to be: changing professional standards and awareness; policies acknowledging of the effects of conflict; anti-discrimination legislation; development of rehabilitation services; and the reform of disability benefits. Inter alia, health professionals' attitudes towards victims and their treatment of injury appear to have a significant influence on outcomes for injured people.