Osseointegration for the Reconstruction of Devastating Military and Terrorist Blast Injuries

Blast injuries from military related explosions often result in devastating lower extremity injuries. With soft tissues and bone obliterated by the force of the explosion, the associated gross destruction of the extremities frequently results in lower limb amputations. These injuries are often bilateral, and can be notoriously difficult to fit with prostheses because of a short skeletal residuum, dense adherent scars, and heterotopic bone. Osseointegration provides an innovative strategy for the management of these problematic amputees, using a transcutaneous porous-coated titanium endo-prosthetic device. The primary objective of this study is to describe our experience of using osseointegration as the definitive reconstruction strategy in these difficult cases.

This is a case series of 10 patients who had sustained military or terrorist blast injuries resulting in lower extremity amputations. 10 men aged between 23-67 (mean 37) years were included. Clinical outcomes were obtained pre- and post-operatively from 10 to 30 months with a mean follow-up of 16 months. Principle outcome measures included the Questionnaire for persons with a Trans-Femoral Amputation (Q-TFA), Short Form Health Survey 36 (SF-36), K-levels, Six Minute Walk Test (6MWT), and Timed Up and Go (TUG). Adverse events were recorded including infection, revision surgery, fractures, and implant failures.

Compared to the mean pre-operative values with socket prostheses, the mean post-operative values for all five validated outcome measures were improved. There were episodes of minor infection in 3 patients, but all of these responded to oral antibiotics. Refashioning of the soft tissue residuum was performed on 1 patient electively. One peri-prosthetic fracture occurred due to increased activity, and was successfully stabilized without the need to revise the implant.

Our experience in this small series suggests that osseointegration may be considered a highly effective strategy for the reconstruction of amputees resulting from military-type blast injuries.