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The article discusses aspects, considerations and operating procedures of traumatic and trauma-related upper-extremity amputations. The optimization of clinical outcomes is said to be depending on the knowledge of proper amputation techniques, judicious use of tissue coverage and preferred amputation levels. Participation of a multidisciplinary team of surgeons, nurses and prosthetists claims to be an important factor to maximize patient rehabilitation aside from the expertise of the surgeon.

The article discusses a study which examines the value of reoperations or surgical treatment of complications following a major upper extremity amputation. It details the retrospective analysis of the outcome measures from combat-wounded personnel with major upper-extremity amputations, including prosthesis use and type, presence of residual limb pain, and pain medication. The findings reveal that revision amputation for surgical complications can significantly improve outcomes.

Damage control orthopaedics is well described for civilian trauma. However, significant differences exist for combat-related extremity trauma. Military combat casualty care is defined by levels of care. Each level of care has a specific role in the care of the wounded patient. Because of lack of equipment, austere environments, and significant soft tissue wounds, most combat fractures are stabilized with external fixation even in a stable patient, unlike civilian trauma. External fixation allows for rapid stabilization of fractures and easy access to wounds and requires little shelf stock of implants. Unique situations exist in the care of the combat-injured casualty, which include working in an isolated facility, caring for enemy combatants, large soft tissue wounds, and the need to rapidly transport patients out of the theater of operations.

Musculoskeletal injury is the most common type of injury among survivors of combat trauma, and combat-related trauma is challenging for an orthopaedic surgeon to treat. Methods of treatment are evolving, but significant gaps remain as knowledge of civilian trauma is extrapolated to combat trauma.