Current Concepts Review   |    
Traumatic and Trauma-Related AmputationsPart II: Upper Extremity and Future Directions
LT Scott M. Tintle, MD1; LTC Martin F. Baechler, MD1; CDR George P. Nanos III, MD1; LCDR Jonathan A. Forsberg, MD1; MAJ Benjamin K. Potter, MD1
1 Orthopaedic Surgery Service, Integrated Department of Orthopaedics and Rehabilitation, Walter Reed Army Medical Center, 6900 Georgia Avenue N.W., Building 2, Clinic 5A, Washington, DC 20307. E-mail address for B.K. Potter: Kyle.Potter@amedd.army.mil
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the Walter Reed Army Medical Center, Washington, DC
Disclaimer: The opinions and 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 United States Army, United States Navy, or the Department of Defense.

Copyright © 2010 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Dec 15;92(18):2934-2945. doi: 10.2106/JBJS.J.00258
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Trauma is the most common reason for amputation of the upper extremity.

The morphologic and functional distinctions between the upper and lower extremities render the surgical techniques and decision-making different in many key respects.

Acceptance of the prosthesis and the outcomes are improved by performing a transradial rather than a more proximal amputation. Substantial efforts, including free tissue transfers when necessary, should be made to salvage the elbow.

Careful management of the peripheral nerves is critical to minimize painful neuroma formation while preserving options for possible future utilization in targeted muscle reinnervation and use of a myoelectric prosthesis.

Rapid developments with targeted muscle reinnervation, myoelectric prostheses, and composite tissue allotransplantation may dramatically alter surgical treatment algorithms in the near future for patients with severe upper-extremity trauma.

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