{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T02:33:00Z","timestamp":1787884380894,"version":"build-2784847793"},"reference-count":57,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2019,3,29]],"date-time":"2019-03-29T00:00:00Z","timestamp":1553817600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&amp;R"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Limited population\u2010based research has described long\u2010term health outcomes following combat\u2010related upper limb amputation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare health outcomes following upper limb amputation with outcomes following serious upper limb injury during the first 5 years postinjury.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Departments of Defense (DoD) and Veterans Affairs (VA) inpatient and outpatient health care facilities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Three\u2010hundred eighteen U.S. Service Members.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients sustained an above elbow (AE, n\u2009=\u200951) or below elbow (BE, n\u2009=\u200980) amputation or serious arm injury without amputation (NO AMP, n\u2009=\u2009187) in the Iraq or Afghanistan conflicts, 2001 through 2008. Injuries were coded by trauma nurses. Outcomes came from DoD and VA health databases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measurements<\/jats:title><jats:p>\n<jats:italic>International Classification of Diseases, Ninth Revision, Clinical Modification<\/jats:italic> (ICD\u20109\u2010CM) diagnostic codes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Most patients were injured by blast weaponry causing serious to severe injuries. All groups had a high prevalence of physical and psychological health diagnoses. The prevalence for nearly all wound complications and many physical and psychological disorders decreased substantially after postinjury year 1. The prevalence of posttraumatic stress disorder, however, increased significantly from postinjury year 1 (20%) to 3 (36%). Pain and psychological disorders ranged from 69% to 90% of patients during postinjury year 1 and remained relatively high even postinjury during year 5 (37%\u201053%). After adjusting for covariates, the AE group had significantly higher odds for some physical and psychological diagnoses (eg, deep vein thrombosis\/pulmonary embolism, cervical pain, osteoarthritis, obesity, and mood and adjustment disorders) relative to the BE or NO AMP groups. BE patients had significantly lower odds for osteomyelitis, and AE and BE patients had lower odds for fracture nonunion and joint disorders versus NO AMP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The results identify similarities and differences in clinical outcomes following combat\u2010related upper limb amputation versus serious arm injury and can inform medical planning to improve rehabilitation programs and outcomes for these patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>III<\/jats:p><\/jats:sec>","DOI":"10.1002\/pmrj.12047","type":"journal-article","created":{"date-parts":[[2019,3,29]],"date-time":"2019-03-29T18:59:05Z","timestamp":1553885945000},"page":"577-589","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["A Retrospective Comparison of Five\u2010Year Health Outcomes Following Upper Limb Amputation and Serious Upper Limb Injury in the Iraq and Afghanistan Conflicts"],"prefix":"10.1002","volume":"11","author":[{"given":"Ted","family":"Melcer","sequence":"first","affiliation":[{"name":"Department of Medical Modeling, Simulation, and Mission Support Naval Health Research Center, 140 Sylvester Road  San Diego CA 92106\u20103521"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay","family":"Walker","sequence":"additional","affiliation":[{"name":"Department of Medical Modeling, Simulation, and Mission Support Naval Health Research Center, Leidos  San Diego CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"II","given":"Vernon Franklin","family":"Sechriest","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Minneapolis Veterans Affairs Hospital, Minneapolis VA Health Care System  Minneapolis MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vibha","family":"Bhatnagar","sequence":"additional","affiliation":[{"name":"VA San Diego Healthcare System  San Diego CA"},{"name":"Department for Family and Preventive Medicine University of California San Diego La Jolla CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Richard","sequence":"additional","affiliation":[{"name":"VA San Diego Healthcare System  San Diego CA"},{"name":"Department for Family and Preventive Medicine University of California San Diego La Jolla CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katheryne","family":"Perez","sequence":"additional","affiliation":[{"name":"Department of Medical Modeling, Simulation, and Mission Support Naval Health Research Center, Leidos  San Diego CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Galarneau","sequence":"additional","affiliation":[{"name":"Department of Medical Modeling, Simulation, and Mission Support Naval Health Research Center  San Diego CA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,3,29]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e318275469c"},{"key":"e_1_2_7_3_1","first-page":"265","volume-title":"Care of the Combat Amputee","author":"Pasquina PF","year":"2009"},{"key":"e_1_2_7_4_1","unstructured":"Defense Health Agency. 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