Prevalence and Aetiology of Various Levels of Traumatic Limb Amputations Following Traumatic Injuries at Kenyatta National Hospital

Abstract

Background: Traumatic limb amputation significantly contributes to morbidity among trauma patients. Due to urbanization, the incidence of traumatic limb amputations is increasing rapidly. Whereas amputations are only performed in around 1% of all trauma patients, they are linked with severe morbidity and a death rate of over 15%. Accidental traumatic amputations account for most civilian traumatic amputations linked to Moving Vehicle crashes (MVC), machinery, and gun violence. Limitations in data availability in developing countries hinder proper planning and resource mobilization toward preventing limb amputations and the care of patients with the condition. Objectives: This study was to establish the prevalence and etiology of various levels of traumatic limb amputation at Kenyatta National Hospital. Methodology: This study adopted a hospital-based cross-sectional study. A consecutive sampling technique was used to recruit 245 orthopedic trauma patients at Kenyatta National hospital. Data was on socio-demographics, etiology, and level of traumatic limb amputations. The outcome variable was occurrence of traumatic limb amputations. Data analysis was done using SPSS version 25. The prevalence of traumatic limb amputation was calculated as a proportion of all patients presenting with traumatic injuries and expressed in percentage. Logistic regression analysis was conducted to investigate causes of traumatic limb amputation. The level of significance was evaluated at p<0.05. Results: The median age was 34 years (IQR: 26 – 43) with 57.6 %( n =141) of the respondents being aged between 18 to 35 years. Majority, 84.1 %( n =206) of the patients were male. The prevalence of traumatic limb amputation was 5.3%, 95%CI: 2.9% to 8.9%. Mechanism of injury revealed that 58.4 %(n =143) were as a result of road traffic accidents and 25.7%(n =63) were due to fall from height. Further, 58.4 %( n =143) had closed fractures with 18.8 %( n =46) had injuries on left and right sides, 58% (n =142) had injury on their lower limb. The common site of injury were tibia 29.4 %(n =72), femur 26.1%(n =64) and spine 23.3%(n =57). The prevalence of traumatic limb amputation was 5.3%, 95%CI: 2.9% to 8.9%. Among those with limb amputation, 61.5% (n =8) of patients had lower limb amputation while 38.5 %(n =5) had upper limb amputation. Those who had machinery as mechanism of injury, OR =4.24, 95%CI: 1.21 – 14.91, those presenting with open fracture, OR =8.52, 95%CI: 1.85 – 39.34, p =0.006 and those who had lower limb as location of injury, OR =3.19, 95%CI: 1.19 – 10.28, p =0.005 were more likely to have limb amputation. Conclusion and recommendations: The prevalence of limb amputation is high with most of the amputation being lower limb amputations. Injuries from machinery and open fractures have been found as major causes of limb amputation. It is fundamental to incorporate better safety guidelines in handling of machinery to improve better management outcomes