LONG-TERM FUNCTIONAL OUTCOME AND QUALITY OF LIFE IN PATIENT AFTER SEVERE POLYTRAUMA

Abstract

Case History: A female of 30 years old had a severe polytrauma with multiple pelvic fractures, bilateral fractures of crural bones, traumatic injury of a.poplitea dxt. In spite of several efforts to perform vascular reconstruction of the right leg, the gangrene of the right foot continued to progress. This resulted in the amputation of the right leg at the middle third level of the femur. The pelvis was fixed with alocking plate at posterior access and an acetabular component with cannulated screw at anterior access. Clinical Findings: The patient’s physical state was evaluated according to the Amputee Mobility Predictor (AMP) (1). It was performed at 2 years post-polytrauma and resulted with a K3 functional level. Investigation/Results: Electromyography of the left lower extremity presented a n. tibialis sin. deep axonal injury above left knee joint. Diagnosis: Right side transfemoral amputation, secondary to traumatic etiology, n. tibialis sin. deep axonal injury above left kneejoint. Therapy and Progression: Majeed score (2) at 2 years post-polytrauma 88 points (excellent). The mobility according with modified Lower Extremity Functional Scale (LEFS) questionnaire (3) was 79% of the maximum possible. Comments: This case demonstrantes the significance of long-term follow-up with necessary out-patient treatment and rehabilitation of patients following severe polytrauma. Results indicate follow-up care improves the quality of life in patients. Modified LEFS could be used to evaluate the mobility of transfemoral amputees. However, the validity of these modifications must be determined by administering such modified questionnaire to a larger group of patients following transfemoral amputation with consequent statistical analysis of the received results. References: 1) Gailey RS, Roach KE, et al. The amputee mobility predictor: an instrument to assess determinants of the lower-limb amputee’s ability to ambulate // Arch Phys Med Rehabil. 2002 May;83(5):613-627 2) Majeed SA. Grading the outcome of pelvic fracture // J Bone Joint Surg Br 1989 Mar; 71(2):304– 306 3) Binkley JM1, Stratford PW, et al. The Lower Extremity Functional Scale (LEFS): scale development, measurement proper ties, and clinical application. North American Orthopaedic Rehabilitation Research Network // Phys Ther. 1999 Apr;79(4):37183. Disclosure: No significant relationships.