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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 18  |  Issue : 4  |  Page : 196-199  

Pattern of limb amputations in Liberia


1 Department of Surgery, John F. Kennedy Memorial Hospital, Monrovia, Liberia
2 Department of Surgery, John F. Kennedy Memorial Hospital, Monrovia, Liberia; Orthopaedic Unit, Department of Surgery, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria

Date of Web Publication05-Dec-2019

Correspondence Address:
Dr. Mohammed Kabir Abubakar
Orthopaedic Unit, Department of Surgery, Aminu Kano Teaching Hospital, Bayero University, P.M.B. 3011, Kano

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aam.aam_19_19

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   Abstract 


Background: Amputation is one of the oldest known surgical procedures. It has been one of the modalities of applying judgment and treatment. Its method and indications has evolved over time. Modern amputation is regarded as a part of treatment rather than failure of treatment. Amputation is the removal of a limb or part of a limb through on or more bone. When through a joint is referred to as disarticulation. Data on the profile and pattern of amputation in Liberia will add to the body of knowledge. Aim and Objectives: Is to describe the pattern of limb of amputations in Liberia. Also to describe the anatomical variations of limb amputations in Liberia. Patients and Method: A retrospective study of all patients that underwent limb amputation surgeries in the John F Kennedy Memorial (JFK M), Hospital , Monrovia Liberia between January 2010 to December 2015. Results: 100 patients had limb amputations between 2010 and 2015. Males(73) to female(27) ratio were 2.4:1. The age range was 9 - 91 years. Mean age was 42.9 years. The indications for amputations were Trauma 24%, Diabetes 29%, Gangrene (6%), Chronic ulcer (25%), Tumour (5%). Below knee(47%), Above Knee(45%), Below elbow(2%), Above Elbow(2%), Knee Disarticulation(2%), and Big Toe Disarticulation(2%). Conclusion: The profile of Limb amputation in Liberia is not very different from what is obtaining in the region. However the limitations of histology and other investigative procedure have affected the accurate diagnosis of certain conditions like tumours.

   Abstract in French 

Résumé
Contexte: L amputation est l'une des vieilles interventions chirurgicales connues. Elle a ete une des modalitees exigeant un choix judicieux et le traitement adequat. Ses methodes et indications ont evoluer aucours de temps. L' amputation moderne est consideree comme faisant partie du traitement plutot que de l' echec therapeutique. L amputation est definie comme l' ablation d' un member ou d une partie de membre au a travers d' un ou des plusieurs os. Quand ,elle se fait au niveau d'une articulation, celle ci s' appellee la desarticulation. Les donnees sur le profil et structure de l amputation au Liberia ajouteront un plus de conaissance au corps academique. But et objectifs: C' est de decrire le mode d'amputation du member au Liberia; Ainsi que ses variations anatomiques. Patients et Methode: Une etude retrospective de tous les Patients ayant subit l' amputation chirurgicale du membre a John F kennedy Memorial Hospital, Monrovia, Liberia entre janvier 2010 jusque decembre 2015.
Resultas: 100 patients ont subit les amputations entre 2010 et 2015. Males :73, Femeles: 27, Sexe ratio :2.4/1, Tranche d 'age :9-91ans, Age moyen: 42,9 ans, Indications des amputations: Diabetes:29%, Ulceres chroniques:25%, Traumatisme: 24%, Gangrene: 6%, Tumeures: 5%, Au dessous du genou: 47%, Au dessus du genoux: 45%, En dessous du coude: 2%, Au dessus du coude:2%, Disarticulation du genou: 2%, Desarticulation du gros orteil : 2%. Conclusion: Le profil sur les amputations des membres au Liberia n' est pas tres different de ce obtenu dans la region. Cependant ,carence en histologie et autres investigatios paracliniques ont affectees le diagnostique precis des certaines conditions comme les tumeurs.

Keywords: Liberia, limb amputation, pattern


How to cite this article:
Weyhee JK, Abubakar MK, Muvunandinda E, Okao P, Geu AD. Pattern of limb amputations in Liberia. Ann Afr Med 2019;18:196-9

How to cite this URL:
Weyhee JK, Abubakar MK, Muvunandinda E, Okao P, Geu AD. Pattern of limb amputations in Liberia. Ann Afr Med [serial online] 2019 [cited 2020 Nov 27];18:196-9. Available from: https://www.annalsafrmed.org/text.asp?2019/18/4/196/272401




   Introduction Top


Amputation is one of the oldest known surgical procedures. It has been practiced by the Egyptian since the Babylonian times. It has been one of the modalities of applying judgment and treatment. Its method and indications have evolved over time. Modern amputation is regarded as a part of treatment rather than a failure of treatment. Amputation is the removal of a limb or part of a limb through one or more bone. When through a joint is referred to as disarticulation, it is term major if the amputation is carried out above the wrist or the ankle.[1],[2] Globally, the indications for amputations varies with trauma and diabetes limb disease being the leading cause in developing countries and peripheral vascular disease, diabetic limb disease constituting the leading indications in the developed nations.[2] In the USA, an estimated 180,000 limb amputations are carried out every year.[3] In developing countries such as Nigeria and Rwanda, it has been reported that the prevalence of amputation is 1.6–3.2/100,000 population.[4],[5]

Liberia which is a typical developing country has a population of 4,943,490.[6] There is no document data on the extent of limb amputation in the country. Amputation has a life-changing effect on the patient because of the permanent disability if cause. It affects patients psyche and morals. The patient dignity and livelihood may be eroded. Thus, there is a major cultural and often social rejection associated with amputation.[7],[8]

Data on the profile and pattern of amputation in Liberia will add to the body of knowledge. However, most importantly, it will serve to highlight the burden of the problem and also serve as a possible yardstick for the government and the community to increase educational programs and policies that will ensure early intervention in disease processes and prevention of complications that will result in amputations.


   Patients and Methods Top


A retrospective study of all patients that underwent limb amputation surgeries in the John F Kennedy Memorial (JFK M) Hospital, Monrovia, Liberia, between January 2010 and December 2015. The JFK M, Hospital, Monrovia, is the largest tertiary hospital in Liberia. The most patient requiring orthopedic intervention like amputations is referred to the facility. Records were obtained from the operating theater register; and in certain cases, further information was obtain from the patient's case record. Information regarding demography, indication for amputation, type of amputation, complications, and length of hospital stay. Data obtained were analyzed using SPSS Version (IBM SPSS Statistics for Windows, Version 24.0, IBM Corp., Armonk, NY).

The result was presented in descriptive statistics.


   Results Top


100 patients had limb amputations between 2010 and 2015 [Table 1] and [Figure 1]. Males (73) to female (27) ratio were 2.4:1.) [Table 2].and [Figure 2]. The age range was 9 - 91 years. Mean age was 42.9 years [Figure 3]. The indications for amputations were Trauma 24%, Diabetes 29%, Gangrene (6%), and chronic ulcer (25%), Tumour (5%) [Table 3]. Below knee(47%), Above Knee(45%), Below elbow(2%), Above Elbow(2%), Knee Disarticulation(2%), and Big Toe Disarticulation(2%) [Table 4].
Table 1: Frequency of amputation per year

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Figure 1: Number of amputation/year

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Table 2: Gender distribution of patient

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Figure 2: Gender distribution of patients

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Figure 3: Age distribution of patients

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Table 3: Indication for amputation

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Table 4: Surgical procedures

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   Discussion Top


Records of 100 patients that had limb amputations between 2010 and 2015 were analyzed. Male: female ratio was 2.4:1. The age range was 9 and 91 years with a mean of 42.9 years. The male: female ratio is similar to what was obtained studies carried out around the African region of 2.5–4.4:1.[1],[2],[7],[9],[10],[11] However, it is lower than what is obtain in the Europe and the USA.[12],[13] The fact that males are more affected might not be unconnected to the higher number of males that are engage in predisposing factors such as travels, military activities, and working in farms and factories. The mean age 42.9 years is consistent with similar studies in Africa and other developing countries because of the relative younger age population and because trauma which is the major cause in this environments is more common among the youth populations.[1],[2],[7],[9],[10],[14],[15]

90% of amputations involve the lower limb. This is consistent with most studies globally.[1],[2],[7],[12],[13],[14],[16] The lower limb is particularly at risk of trauma, diabetic foot peripheral vascular disease.[1],[2],[4],[5],[7],[8] There was a prevalence of 100% unilateral amputation in our study. This slightly differs with studies around the region whereby most have low but significant prevalence of bilateral amputations.[1],[2],[7],[9],[12],[13],[14],[15],[16] Diabetic-associated gangrene is the leading indication for amputation (29%). This is similar to what was obtain most studies around the region.[2],[12],[14],[17] There is also a high prevalence of trauma-associated amputations (24%). Some studies around the subregion also indicated a high prevalence of trauma-associated amputations.[1],[9] The number of patients, its chronic leg ulcers leading to infective gangrene is quite common (25%). This may be due to the limited ability to make microbiological diagnosis. Thus, appropriate sensitive antibiotics may not be identified for use in the treatment of infected leg ulcers. Like most reports from the subregion, peripheral vascular disease is low (6%).[1],[2],[14],[17] In general, there is a lower prevalence of peripheral vascular disease in Africa compared to the Europe and North America and Asia.[1],[2],[7],[13]

Tumors, though low, are not uncommon. Due to the lack of facilities for histological diagnosis, we relied on cytology and clinical diagnosis to make a presumptive diagnosis of tumors. Sixteen patients had amputations from a presumptive diagnosis of tumor. This prevalence is consistent with what was obtained in other studies around the region.[1],[2],[7],[15] Like most global reports, lower limb amputations are more are more (92%),[1],[9],[12],[14],[16] with below knee slightly more than above knee 47 and 45, respectively. This is largely similar to what was obtained in majority of amputations obtained around the region.[1],[9],[12],[14],[16] This may not be unconnected to the fact that trauma to the leg is the most common indication for amputation in the African region.[1],[2],[5],[9]


   Conclusion Top


The profile of limb amputation in Liberia is not very different from what is obtaining in the region. However, the limitations of histology and other investigative procedure have affected the accurate diagnosis of certain conditions such as tumors. This has made the diagnosis to be mainly clinical.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Mamuda AA, Salihu MN, Abubakar MK, Adamu KM, Ibrahim M, Musa MU. Profile of amputations in national orthopaedic hospital, Dala, Kano. Open J Orthop 2014;4:200-4.  Back to cited text no. 1
    
2.
Odatuwa-Omagbemi DO. Pattern of limb amputations in male patients in a Nigerian teaching hospital. J Dent Med Sci 2014;13:42-5.  Back to cited text no. 2
    
3.
Ziegler-Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R. Estimating the prevalence of limb loss in the united states: 2005 to 2050. Arch Phys Med Rehabil 2008;89:422-9.  Back to cited text no. 3
    
4.
Thanni LO, Tade AO. Extremity amputation in Nigeria – A review of indications and mortality. Surgeon 2007;5:213-7.  Back to cited text no. 4
    
5.
Murwanashyaka E, Ssebuufu R, Kyamanywa P. Prevalence, indications, levels and outcome limb amputations at university teaching hospital-Butare in Rwanda. East Cent Afr J Surg 2013;18:103-7.  Back to cited text no. 5
    
6.
Available from: http://www.worldometer.info/worldpopulation/Liberia-population. [Last Accessed on 2019 Mar 23].  Back to cited text no. 6
    
7.
Yinusa W, Ugbeye ME. Problems of amputation surgery in a developing country. Int Orthop 2003;27:121-4.  Back to cited text no. 7
    
8.
Udosen AM, Ngim N, Etokidem A, Ikpeme A, Urom S, Marwa A. Attitude and perception of patients towards amputation as a form of surgical treatment in the university of Calabar teaching hospital, Nigeria. Afr Health Sci 2009;9:254-7.  Back to cited text no. 8
    
9.
Ajibade A, Akinniyi OT, Okoye CS. Indications and complications of major limb amputations in Kano, Nigeria. Ghana Med J 2013;47:185-8.  Back to cited text no. 9
    
10.
Selby JV, Zhang D. Risk factors for lower extremity amputation in persons with diabetes. Diabetes Care 1995;18:509-16.  Back to cited text no. 10
    
11.
Talona L, Maoneo A, Kuyigwa T, Ossinga B, Lomodo L, Ahuka OL. Overview of epidemiological and etiological amputation in Kisangani democratic republic of Congo (DRC). Open J Epidemiol 2016;6:154-9.  Back to cited text no. 11
    
12.
Amtmann D, Morgan SJ, Kim J, Hafner BJ. Health-related profiles of people with lower limb loss. Arch Phys Med Rehabil 2015;96:1474-83.  Back to cited text no. 12
    
13.
Pernot HF, Winnubst GM, Cluitmans JJ, De Witte LP. Amputees in Limburg: Incidence, morbidity and mortality, prosthetic supply, care utilisation and functional level after one year. Prosthet Orthot Int 2000;24:90-6.  Back to cited text no. 13
    
14.
Umuru H, Madubueze CC, Alada A, Onu CM. Limb amputations in Nigeria: The national hospital Abuja experience. Niger J Surg Res 2015;16:111-4.  Back to cited text no. 14
    
15.
Shojaiefard A, Khorgami Z, Larijani B. Septic diabetic foot is not necessarily an indication for amputation. J Foot Ankle Surg 2008;47:419-23.  Back to cited text no. 15
    
16.
Rathore FA, Ayaz SB, Mansoor SN, Qureshi AR, Fahim M. Demographics of lower limb amputations in the Pakistan military: A single center, three-year prospective survey. Cureus 2016;8:e566.  Back to cited text no. 16
    
17.
Nwosu C, Babalola MO, Ibrahim MH, Suleiman SI. Major limb amputations in a tertiary hospital in North Western Nigeria. Afr Health Sci 2017;17:508-12.  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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